Content:
- Hospitalizations and deaths on RSV infection in the Czech Republic in the year 2023 – Petr Pazdiora, Ondřej Šanca, Ladislav Dušek
- Surveillance of serious diseases caused by Haemophilus influenzae in the Czech Republic in 2009–2023 – Ludmila Nováková
- Analysis of the clinical effectiveness of oral antivirals in covid-19 in the Czech Republic – Lenka Petroušová, Jiří Slíva, Jan Smetana
- Measles – situation in the Czech Republic and in the world in the context of the current unfavourable epidemiological situation – Radomíra Limberková, Monika Liptáková, Zdenka Manďáková, Lada Svobodová, Jan Kynč
- New approaches to vaccination against pneumococcal infections – Roman Prymula
Editorial
Vážení čtenáři, kolegové a kolegyně,
v oblasti vakcinologie dnes stojíme před zcela novými výzvami, které zahrnují nejen řešení epidemiologických hrozeb, ale také efektivní zavádění nových zdravotnických technologií (Health Technology Assessment, HTA) do rozhodovacích procesů. HTA představuje klíčový nástroj pro hodnocení přínosu nových vakcín, zajištění jejich dostupnosti a spravedlivé distribuce v rámci zdravotního systému.
Základním principem HTA je poskytovat informovaná rozhodnutí na základě klinické efektivity, nákladové efektivity, bezpečnosti a etických aspektů. V oblasti vakcinace má tento proces strategický význam při rozhodování o zařazení nových vakcín do národních imunizačních programů. Například pandemická situace způsobená covidem-19 ukázala, jak důležité je rychlé, ale pečlivé vyhodnocení nových intervencí, aby bylo možné co nejefektivnější využití omezených zdrojů.
Zavádění HTA do posuzování vakcín přináší řadu výhod. Za prvé, HTA umožňuje systematické hodnocení klinických a ekonomických dopadů, což je nezbytné pro spravedlivé rozhodování. Za druhé, tento nástroj poskytuje rámec pro identifikaci priorit, ať už jde o investice do výzkumu nebo o podporu konkrétních vakcinačních programů. Za třetí, HTA podporuje transparentnost a důvěru veřejnosti v rozhodovací procesy, což je obzvláště důležité při zavádění nových vakcín do očkovacího kalendáře v době, kdy narůstá odpor proti očkování jako takovému.
Legislativní proces se nedávno poněkud zadrhnul, neboť tato legislativní úprava směřovala ze Senátu do Poslanecké sněmovny a sněmovna normu nepustila dále. Teď je druhá šance, kdy zainteresované strany deklarují snahu, aby byla tato důležitá norma schválena. Věřme, že se to podaří a budeme i v České republice tento proces reálně řídit a nespoléhat pouze na náhodný lobbing.
V současné době také řešíme „nový“ virus HMPV. Tedy spíše ho řeší masmédia. Je vidět, že dnes je síla masmédií prakticky neomezená, a když se rozhodnout „vyrobit“ nějakou kauzu, tak ji prostě vyrobí bez ohledu na reálnou nebezpečnost případného původce.
Zároveň mi dovolte pogratulovat všem našim členům, kteří byli zvoleni do výborů jiných společností. Posilujeme tak možnost postupovat koordinovaně a harmonizovat doporučení různých odborných společností.
Za redakční radu prof. MUDr. Roman Prymula, CSc., Ph.D.
Hospitalizations and deaths on RSV infection in the Czech Republic in the year 2023
Summary
Objectives: Due to the lack of current data on the seriousness and seasonality of respiratory syncytial virus (RSV) infections in the Czech Republic, an analysis was made of available data on hospitalizations and an estimation of the risk of hospitalization for individual age groups was made.
Methodology: Data from the National Register of Insurance Covered Health Services and the National Register of Hospitalizations were used for the analyses. The number of hospitalizations and deaths due to RSV infection (diagnoses J12.1, J20.5, J21.0) was analyzed according to age groups for the year 2023.
Results: There were 1,865 hospitalizations with presented diagnoses in the year 2023. The rate of hospitalization for the year studied was estimated at 17.11 per 100,000 inhabitants for the diagnoses J12.1, J20.5, and J21.0. From the analysis of age groups, the highest risk was calculated for ages up to 6 months (1313.55/100,000), the lowest for the age group 20–34 (0.57/100,000 inhabitants and year). Hospitalized children under 1 year of age comprised 47.1% of all of hospitalizations with an observed diagnosis while the percentage of patients 65 years and older was 28.3% of inpatients. From those hospitalized with the diagnoses J12.1, J20.5, and J21.0, 72 deaths were reported, i. e. 3.9%. The highest case fatality rate (12.9%) was observed in the age group 65 years and older.
Conclusions: Hospitalization resulting from RSV infection concerns all age groups in the Czech Republic. The highest hospitalization rate was calculated for children under 6 months of age in the year 2023. The highest case fatality rate was calculated for the age group 65 years and older. Collected data is an essential basis for optimizing the targeted use of available methods of prevention, not only for children, but elderly people as well.
Keywords:
RSV, hospitalization, deaths, age, prevention
Petr Pazdiora,1 Ondřej Šanca,2 Ladislav Dušek2,3
1Ústav epidemiologie, Lékařská fakulta v Plzni, Univerzita Karlova
2Ústav zdravotnických informací a statistiky České republiky
3Institut biostatistiky a analýz, Lékařská fakulta, Masarykova univerzita
Surveillance of serious diseases caused by Haemophilus influenzae in the Czech Republic in 2009–2023
Summary
Introduction: Haemophilus influenzae, especially H. influenzae serotype b, is an important pathogen that causes serious diseases such as meningitis, epiglottitis, sepsis or pneumonia. Since the introduction of mandatory childhood vaccinations in the Czech Republic in 2001, the epidemiological situation of invasive haemophilus disease has changed substantially, with most infections now being caused by strains other than H. influenzae b.
Methods: Surveillance of invasive diseases caused by H. influenzae b was started in the Czech Republic in 1999 and expanded to include surveillance of invasive diseases caused by H. influenzae of all serotypes in 2008. The surveillance database is created by linking routinely reported epidemiological data into the infectious diseases information system with the database of the National Reference Laboratory for Haemophilus Infections. Strains of H. influenzae are sent to the National Reference Laboratory for Haemophilus Infections on Transport Medium (Amies) or on Chocolate agar to verify identification and determine the serotype.
Results: A total of 365 invasive haemophilus diseases were recorded between 2009 and 2023. The mortality rate ranged from 0–32%. In the monitored period, sepsis was the most frequently reported (195 cases), the most common causative agent was H. influenzae non-typable (230 cases, 63%), H. influenzae b caused only 21 diseases (6%). Eight cases involved vaccination failure.
Conclusion: Invasive diseases caused by H. influenzae still occur in the Czech Republic even after the introduction of routine vaccination of children against serotype b, but the main causative agent of the disease has changed. Serious diseases caused by H. influenzae b are currently rare and the main causative agent of invasive diseases has become H. influenzae non-typable.
Keywords:
Haemophilus influenzae b, Haemophilus influenzae non-typable, invasive disease, surveillance, vaccination
Ludmila Nováková
Národní referenční laboratoř pro hemofilové nákazy, Státní zdravotní ústav, Praha
Analysis of the clinical effectiveness of oral antivirals in covid-19 in the Czech Republic
Summary
Introduction: Orally administered antivirals are an important tool in the treatment of covid-19 and in preventing the progression to the severe course of the disease. Two antivirals available in the Czech Republic are nirmatrelvir/ritonavir (Paxlovid) and molnupiravir (Lagevrio). The aim of the study was to assess the clinical effectiveness against death and severe course of covid-19 disease and to make a comparison based on the analysis of data from real clinical practice in the Czech Republic.
Methods: A retrospective observational analysis was performed using data from the National Register of Reimbursed Health Services and the Czech National Information System of Infectious Diseases. For the analysis, we selected the period when both drugs were available on the market in the Czech Republic, from 1 November 2022 to 1 December 2023. Patients with covid-19 disease were divided into three cohorts: 1) treatment with nirmatrelvir/ritonavir; 2) treatment with molnupiravir; 3) other treatment without the use of these antivirals (controls).
Results: Between 1 November 2022 and 1 December 2023, 144 966 infections were identified for a surveillance horizon of 30 days from the first positive test. A total of 12 815 infections treated with nirmatrelvir/ritonavir and 24 957 infections treated with molnupiravir were identified. The number of control infections not treated with either nirmatrelvir/ritonavir or molnupiravir was 107 194. In both actively treated groups, there was a decrease in the number of deaths from any cause during the follow-up period compared to the control group. The Hazard Ratio was calculated as 0.09 (95% CI: 0.06–0.12) for nirmatrelvir/ritonavir and 0.32 (95% CI: 0.28–0.37) for molnupiravir. In a direct comparison of the two antivirals, superiority of nirmatrelvir/ritonavir was found, Hazard Ratio: 0.41 (95% CI: 0.28–0.60). Hospitalization for any reason also decreased in the actively treated group compared with the control group. Hazard Ratio was found to be 0.35 (95% CI: 0.32–0.38) for nirmatrelvir/ritonavir and 0.67 (95% CI: 0.64–0.71) for molnupiravir. A direct comparison of the two antivirals revealed superiority of nirmatrelvir/ritonavir, Hazard Ratio: 0.67 (95% CI: 0.61–0.75). In the case of hospital admissions to intensive care units or anaesthesia and resuscitation units due to covid-19 disease, lower numbers were observed in the actively treated groups than in controls. Hazard Ratio was found to be 0.22 (95% CI: 0.15–0.31) for nirmatrelvir/ritonavir and 0.51 (95% CI: 0.43–0.62) for molnupiravir. Direct comparison of the two antivirals revealed superiority of nirmatrelvir/ritonavir, Hazard Ratio: 0.54 (95% CI: 0.35–0.83). Hospital admissions using oxygen therapy for covid-19 disease were also noted to be lower in the actively treated group than in controls. Hazard Ratio was found to be 0.12 (95% CI: 0.09–0.17) for nirmatrelvir/ritonavir and 0.38 (95% CI: 0.34–0.44) for molnupiravir. Direct comparison of the two antivirals revealed superiority of nirmatrelvir/ritonavir, Hazard Ratio: 0.45 (95% CI: 0.31–0.64).
Conclusion: The analysis demonstrated the clinical effectiveness of both oral antivirals nirmatrelvir/ritonavir (Paxlovid) and molnupiravir (Lagevrio) in adults compared to an untreated control group. In a direct comparison, superiority of nirmatrelvir/ ritonavir was found for all parameters studied.
Keywords:
covid-19, oral antivirals, efficacy, Czech Republic
Lenka Petroušová,1,2 Jiří Slíva,3 Jan Smetana4
1Klinika infekčního lékařství, Fakultní nemocnice, Ostrava
2Katedra interních oborů, Lékařská fakulta, Ostravská univerzita, Ostrava
3Ústav farmakologie, 3. lékařská fakulta, Univerzita Karlova, Praha
4Katedra epidemiologie, Vojenská lékařská fakulta, Univerzita obrany, Hradec Králové
Measles – situation in the Czech Republic and in the world in the context of the current unfavourable epidemiological situation
Summary
Measles is a highly contagious, serious exanthematic viral disease that is one of the most common causes of childhood mortality and is the subject of an elimination effort by the World Health Organization (WHO). In recent years, the global situation in the incidence of measles has been unfavourable, and even in European countries, including the Czech Republic (CZ), outbreaks of various magnitude have been occurring. This trend is partly due to the declining vaccination coverage in children, but also due to the gradual decline of post-vaccination antibodies in adults, the so-called waning of immunity. In view of the unfavourable epidemiological situation in the occurrence of measles and the WHO elimination programme, we present an overview of the current situation in the CZ and worldwide with the aim of increasing awareness of the disease, especially among the professionals.
Keywords:
measles, outbreaks, number of cases, vaccination coverage, elimination
Radomíra Limberková,¹ Monika Liptáková,² Zdenka Manďáková,² Lada Svobodová,¹ Jan Kynčl²
¹Národní referenční laboratoř pro zarděnky, spalničky, parotitidu a parvovirus B19, Státní zdravotní ústav Praha
²Oddělení epidemiologie infekčních nemocí, Státní zdravotní ústav Praha
New approaches to vaccination against pneumococcal infections
Summary
New pneumococcal vaccines represent a significant advancement in preventing diseases caused by Streptococcus pneumoniae. These vaccines are designed to cover multiple bacterial serotypes, providing broader protection against various strains that cause serious infections, such as pneumonia, meningitis, and bacteremia and more frequent but less serious otitis. Improved vaccine technologies ensure a stronger immune response and longer-lasting protection, especially in young children and seniors. Clinical studies show high vaccine efficacy in preventing invasive pneumococcal diseases with minimal side effects. Compared to older vaccines, they are also more effective in regions with high antibiotic resistance, a crucial factor in reducing the need for antibiotic treatment. The new vaccines hold substantial potential to reduce illness and mortality from pneumococcal infections across different age and risk groups. Registration of a new 21-valent conjugate vaccine is expected soon, while PCV24, PCV25, PCV31, and a 24-valent vaccine based on the Multiple Antigen Presenting System are also in clinical trial stages.
Keywords:
pneumococcal diseases, IPD, vaccines, PCV
Roman Prymula,1,2
1Ústav preventivního lékařství, Lékařská fakulta Univerzity Karlovy, Hradec Králové
2RIBS Hradec Králové