Content:
- State of vaccination and its effectiveness against rotaviruses among insurees of Dôvera Health Insurance Company in years 2019–2023 – Katarína Minková, Martin Selvek, Beáta Saal, Roman Mužik, Miloš Jeseňák
- The role of HTA in deciding on vaccine reimbursement from public health insurance and the situation in the Czech Republic – Gabriela Volfová, Tomáš Doležal, Jiří Klimeš, Josef Malý
- Vaccination in Travel Medicine – Veronika Jegorova, Milan Trojánek
- Rabies, current prevention options – Lucie Siráková, Petra Polcarová, Martina Malíková, Roman Chlíbek, Jan Smetana
- Poliomyelitis today – Petra Polcarová, Lucie Siráková, Roman Chlíbek, Jan Smetana
- Risks of hepatitis A in flooded areas and the possibility of prevention through vaccination – Jana Prattingerová, Irena Martinková, Vladimír Príkazský, Jan Smetana
- Severe Malaria in a Traveler Returning from Zanzibar – Renata Šindlerová, Aneta Nyčová, Ondřej Beránek, Nicol Bohuslavová, Grigorij Mesežnikov, Jan Beroušek, Jiří Karásek, Lukáš Kolařík, Jolana Havlová, Martin Tulach, Veronika Jegorova, Milan Trojánek
Editorial
Vážení čtenáři, kolegové a kolegyně,
řada z vás navštívila v uplynulém týdnu ve Vídni ESCMID Global, kongres Evropské společnosti pro klinickou mikrobiologii a infekční nemoci (ESCMID). Akce se stala opět jedinečnou příležitostí k reflexi současných trendů v infekční medicíně. Tato obrovská akce přesahující 12 000 účastníků s bohatou účastí i českých odborníků už ztratila původní osobní charakter, jaký si zachovává například ESPID. Akce připomíná monstrózní továrnu na sdělování nových poznatků mikrobiologických, epidemiologických, klinických, laboratorních či vakcinologických. Je třeba říci, že vakcinologie byla zastoupena výrazně častěji než v minulých letech. Dominovaly přednášky o respiračních patogenech (RSV, hMPV, virus chřipky, pneumokoky) či tropických nákazách (horečka dengue). Všudypřítomným tématem napříč přednáškami byla nejen snaha o postpandemickou obnovu důvěry ve vakcinaci, ale i rostoucí důraz na její udržitelnost – klinickou, společenskou a ekonomickou.
Ukazuje se, že vakcíny již nelze vnímat pouze jako nástroj prevence, ale jako komplexní technologii vyžadující sofistikované hodnocení – tedy zavedení HTA (Health Technology Assessment) i pro tuto oblast. A právě na tomto poli došlo k významnému posunu v České republice. 23. dubna prošel třetím čtením Poslaneckou sněmovnou novelizovaný zákon 48/1997 Sb., který nově HTA pro vakcíny zavádí. Jistě to ještě není finále, následuje Senát a podpis prezidenta, ale to by již nemuselo být zásadním problémem.
HTA je nutností, ne byrokratickou překážkou. V době, kdy jsou národní rozpočty pod tlakem a zdravotnické systémy čelí rostoucím nárokům, se HTA stává nepostradatelným nástrojem pro rozhodování o veřejném financování. U léčiv je tento proces již standardem. U vakcín však stále často chybí systematické zohlednění širších přínosů – například vlivu na snížení antibiotické rezistence, přerušení transmise infekcí nebo sociálně-ekonomických dopadů v podobě výpadků pracovní síly během epidemií.
V České republice se HTA vakcín teprve rozbíhá. Zkušenosti ze zahraničí ale ukazují, že tam, kde byla zavedena standardizovaná metodika hodnocení účinnosti, bezpečnosti, nákladové efektivity a společenského dopadu, došlo nejen ke stabilizaci očkovacích programů, ale i ke zvýšení transparentnosti a důvěry veřejnosti.
Zprávy z kongresu ESCMID jasně ukazují, že budoucnost vakcinologie je nejen o vývoji nových antigenů, ale i o schopnosti jejich efektivního zavedení do praxe. HTA představuje nástroj, který může této cestě dát pevné základy. Je na čase, aby se i Česká republika připojila k těm, kdo chápou vakcíny nejen jako injekci, ale jako investici – do zdraví, do stability a do budoucnosti.
Za redakční radu prof. MUDr. Roman Prymula, CSc., Ph.D.
State of vaccination and its effectiveness against rotaviruses among insurees of Dôvera Health Insurance Company in years 2019–2023
Summary
Introduction: Vaccination against rotaviruses is an effective tool for preventing rotaviral gastroenteritis (RVGE) and associated hospitalizations. The aim of this study is to describe the state of vaccination against rotaviruses among children under 5 years of age in Dôvera Health Insurance Company from 2019 to 2023 and to evaluate the impact of vaccination on the incidence of hospitalizations with a diagnosis of RVGE.
Patient Population and Methods: The analysis included insured individuals from Dôvera born between 2019 and 2023, with continuous insurance coverage until the end of June 2024 or until death (n = 106 696). The vaccination status was assessed based on at least one recorded prescription of the rotavirus vaccine (ATC group J07BH) in the healthcare claims data. Hospitalizations with a primary diagnosis of RVGE (A08.0) were monitored among the insured individuals.
Results: Vaccination coverage against rotaviruses in years 2019 to 2023 was at 46.4%. There were significant differences in vaccination rates across various regions of Slovakia, ranging from 32.7% in Košice region to 64.0% in Bratislava region. Higher vaccination rates in a region correlated with a lower incidence of RVGE-related hospitalizations (R = -0.925, p < 0.001). Vaccination against rotaviruses reduced the risk of hospitalization by 84% compared to unvaccinated individuals (HR = 0.16, CI= 0.14–0.18, p < 0.001, adjusted for sex and region).
Conclusion: From 2019 to 2023, less than half of the population under 5 years old was vaccinated against rotaviruses. Vaccination against rotaviruses is a significant independent protective factor for the occurrence of RVGE-related hospitalizations. Increasing vaccination coverage can not only reduce hospitalization risks but also has financial savings effects while preventing adverse outcomes and complications associated with RVGE.
Keywords:
gastroenteritis, hospitalization, rotaviruses, vaccination, vaccination rate
Katarína Minková,1 Martin Selvek,2 Beáta Saal,2 Roman Mužik,2 Miloš Jeseňák3,4
1Všeobecná ambulancia pre deti a dorast, Banská Bystrica
2Dôvera zdravotná poisťovňa, Bratislava, Slovensko
3Klinika detí a dorastu, Jesseniova lekárska fakulta v Martine, Univerzita Komenského v Bratislave, Univerzitná nemocnica Martin
4Ústav klinickej imunológie a lekárskej genetiky, Jesseniova lekárska fakulta v Martine, Univerzita Komenského v Bratislave, Univerzitná nemocnica Martin
The role of HTA in deciding on vaccine reimbursement from public health insurance and the situation in the Czech Republic
Summary
Health Technology Assessment (HTA) is a key tool for objective assessment of the impact of innovative technologies on patient health and the economics of the public health system. In the Czech Republic, HTA is commonly used for the evaluation of medicinal products in the decision-making process on their reimbursement, with the whole process having clearly defined rules set out in advance in the legislation. Currently, there is no similar systematic process for the evaluation of vaccines, which, on the contrary, currently have very little transparency and a politically influenced approval process. Given the importance of vaccines as a key preventive intervention in public health, this is a significant gap in the Czech system, but one that has the potential for early improvement. Following the example of foreign systems, HTA could be included as a mandatory part of the reimbursement approval process for new vaccines in the Czech Republic soon. The intention to improve the Czech system in this area started with a pilot project of the Ministry of Health launched in 2023 and could end with the legislative consolidation of HTA of vaccines in Act No. 48/1997 Coll. on Public Health Insurance and on Amendments and Additions to Certain Related Acts. For successful implementation of HTA vaccines, the continuous development of a local pharmacoeconomic analysis methodology and decision-making process will be essential to capture all potential benefits of the vaccine to society as accurately as possible. Finally, emphasis should be placed on the systematic collection of local data on infectious diseases epidemiology, which is the cornerstone for a relevant outcome of HTA of vaccines. Poor methodology and unrepresentative data can lead to underestimation of the true value of vaccines to society. The aim of this article is to outline the current and future role of HTA in the decision-making process regarding the reimbursement of vaccines from public health insurance in the Czech Republic.
Keywords:
Health Technology Assessment (HTA), cost-effectiveness, public health, vaccines
Gabriela Volfová,1 Tomáš Doležal,2,3 Jiří Klimeš,1 Josef Malý1
1Katedra sociální a klinické farmacie, Farmaceutická fakulta UK v Hradci Králové
2Farmakologický ústav, Lékařská fakulta Masarykovy univerzity, Brno
3Value Outcomes, Praha
Vaccination in Travel Medicine
Summary
With the resurgence of global travel following the COVID-19 pandemic, the prevention of infectious diseases has become a critical aspect of travel medicine. Travelers are at risk of exposure to various pathogens, many of which can be effectively mitigated through vaccination. This review provides an overview of the most frequently recommended vaccines in travel medicine, current guidelines for their administration, and their epidemiological significance in the context of global disease transmission. It underscores the importance of pre-travel consultation, individualized risk assessment, and the application of the 3R vaccination framework (Routine, Required, Recommended) as a cornerstone of pre-travel immunization strategies. Furthermore, the article discusses emerging challenges in travel medicine, including shifts in epidemiological patterns and the increasing relevance of personalized preventive approaches.
Keywords:
travel medicine, travellers’ vaccination, imported infections
Veronika Jegorova, Milan Trojánek
Klinika infekčních nemocí a cestovní medicíny 2. LF UK a FN Motol, Praha
Rabies, current prevention options
Summary
Rabies is undoubtedly one of the most dangerous viral infections transmitted by animals to humans, being lethal in 100% of cases. In more than 150 countries where it is endemic, the most common risk of exposure is from a dog bite. Bat bites are particularly dangerous. Approximately 60,000 people die each year, mostly in areas of Africa and Asia. Preventive options to avoid the disease include vaccination as a part of preexposure prophylaxis (PrEP) and early and consistent initiation of postexposure prophylaxis (PEP). In 2019–2021, the Advisory Committee on Immunization Practices (ACIP, USA) made several updates to the PrEP recommendations, including the following: redefining the risk categories for rabies infection, replacing the three-dose vaccination schedule (D0, D7, D21 or D28) with a two-dose schedule (D0 and D7), ensuring long-term antibody protection of individuals with flexible options, less frequent or no antibody concentration checks for certain at-risk groups, setting the minimum acceptable rabies antibody concentration at 0.5 IU/ml, and ensuring effective vaccination of certain special populations. In the case of PEP, the procedures remain the same as before. Based on the nature of the injury, the type of animal, and the time interval since PrEP was administered, if previously administered, exposures are divided into several categories according to severity. Depending on the category determined, either the vaccine alone or the vaccine concurrently with the administration of rabies immunoglobulin is subsequently administered as part of PEP. The procedures are the same for everyone, including children and pregnant women, as they are life-saving.
Keywords:
rabies, zoonosis, vaccination, preexposure and postexposure prophylaxis, rabies immunoglobulin
Lucie Siráková, Petra Polcarová, Martina Malíková, Roman Chlíbek, Jan Smetana
Katedra epidemiologie, Vojenská lékařská fakulta, Univerzita obrany, Hradec Králové
Poliomyelitis today
Summary
In 1988, the WHO announced the Global Polio Eradication Program (GPEI). To the present, the incidence of poliomyelitis in the world has been reduced by more than 99%, mainly due to large-scale vaccination campaigns using both live attenuated vaccines (OPV) and inactivated vaccines (IPV). Currently, wild poliovirus is endemic only in Afghanistan and Pakistan. A major problem in poliomyelitis eradication is the emergence and spread of vaccine-derived polioviruses (VDPV), which can cause a paretic form of the disease. VDPV circulate mainly in countries where OPV is used, but they can also be imported to other areas. Import is the cause of the detection of VDPV in recent years on the European continent. The eradication of poliomyelitis is further complicated by armed conflicts, the unavailability of vaccines, the frequent subclinical course of the disease, and the covid-19 pandemic has also had a certain impact. To achieve the GPEI goals, it is necessary to increase the effectiveness of vaccination campaigns in risk areas, maintain high IPV vaccination coverage in „polio-free“ countries, and improve the quality of surveillance and timeliness of polio case detection. The latest GPEI strategy supposes the eradication of wild polioviruses and VDPV type 2 by the end of 2029.
Keywords:
poliomyelitis, vaccination, eradication program, surveillance, vaccine-derived poliovirus
Petra Polcarová, Lucie Siráková, Roman Chlíbek, Jan Smetana
Katedra epidemiologie, Vojenská lékařská fakulta, Univerzita obrany, Hradec Králové
Risks of hepatitis A in flooded areas and the possibility of prevention through vaccination
Summary
Acute flood events are linked to a dramatic increase in the risk of transmission of fecal-orally and foodborne infectious diseases, including hepatitis A which is the main focus of this article. The combination of factors such as compromised water quality, insufficient hygiene, food contamination, high population density, disrupted logistics, and limited access to healthcare exponentially increases population vulnerability. Improving water management infrastructure, promoting hygienic practices, and ensuring prioritized access to healthcare, including timely immunization against hepatitis A, represent key interventions for the prevention and management of flood-related health risks. Early vaccination against hepatitis A of all persons at risk of infection is one of the most effective measures.
Keywords:
hepatitis A, vaccination, floods
Jana Prattingerová,1,2,3 Irena Martinková,4 Vladimír Príkazský,3 Jan Smetana2
1Krajská nemocnice Liberec
2Vojenská lékařská fakulta Univerzity obrany, Hradec Králové
3Fakulta zdravotnických studií, Technická Univerzita v Liberci
4Krevní centrum, Frýdek-Místek
Severe Malaria in a Traveler Returning from Zanzibar
Summary
We present the case of a 49-year-old patient with fever, dyspnea, and jaundice after returning from Zanzibar. The laboratory findings included thrombocytopenia, elevated CRP, nitrogenous metabolites, and liver function tests. The patient was diagnosed with Plasmodium falciparum infection with an initial parasitemia of 1.62%. Due to concerning laboratory findings despite the low initial parasitemia, treatment with parenteral artesunate was initiated. Despite appropriate targeted therapy, the patient developed acute renal and respiratory insufficiency, temporarily requiring intensive care. This case illustrates that even a low initial parasitemia can lead to a severe course of malaria, necessitating intensive care. It highlights the importance of early diagnosis, rapid initiation of appropriate therapy, and interdisciplinary collaboration. Furthermore, it emphasizes the lack of awareness about malaria risk among travelers and inconsistent information provided by travel agencies. To prevent similar cases, it is essential to educate travelers, accurately assess the risk in the destination, and ensure adherence to recommended preventive measures, including chemoprophylaxis.
Keywords:
fever, malaria, travel medicine
Renata Šindlerová,1 Aneta Nyčová,1 Ondřej Beránek,1 Nicol Bohuslavová,1 Grigorij Mesežnikov,1 Jan Beroušek,2 Jiří Karásek,3 Lukáš Kolařík,4 Jolana Havlová,5 Martin Tulach,1 Veronika Jegorova,1 Milan Trojánek1
1Klinika infekčních nemocí a cestovní medicíny 2. LF UK a FN Motol, Praha
2Klinika anesteziologie, resuscitace a intenzivní medicíny 2. LF UK a FN Motol, Praha
3Oddělení urgentního příjmu dospělých, FN Motol, Praha
4Oddělení klinické hematologie, FN Motol, Praha
5Ústav lékařské mikrobiologie, 2. LF UK a FN Motol, Praha