The nationwide prospective questionnaire study of cases and controls was implemented during the p... more The nationwide prospective questionnaire study of cases and controls was implemented during the period from October 1996 till May 1998. Thirty-nine districts participated (= 54.2% of district hygiene stations) and 107 invasive meningococcal diseases were included in the study (= 76.9% of diseases recorded during the given period in the Czech Republic by active surveillance). A total of 390 subjects were included in the study-107 with invasive meningococcal diseases, 211 healthy controls and 72 healthy carriers of Neisseria meningitidis. This is the first study in the Czech Republic which analyzes comprehensively socioeconomic, health and stress factors in relation to the genesis and development of invasive meningococcal disease or carriership of N. meningitidis. The relationship between these factors and meningococcal disease or carriership was evaluated by the chi square test: odds ratio (OR) and statistical significance (p for chi square-Yates correction or Fischer's exact test). For the development of invasive meningococcal disease in particular, risk factors are significant (p < 0.05) which at the time weaken the overall resistance of the organism: febrile diseases, respiratory diseases, other diseases, exertion, exposure to cold, mental stress, other stress, injury, staying in places outside the home on brigades, training courses, stay in crowded premises. As to long-term factors the development of the disease is influenced by a contaminated environment, passive smoking and lower education of the mother which indicates a different lifestyle. Conversely, factors negatively correlated with the development of the disease are active participation in sports and favourable economic conditions. For death: significant risk factors (p < 0.05) are also factors which weaken the resistance of the organism: exertion, mental stress, other stress (= alcohol consumption), staying outside the home on brigades, training courses etc. For carriership risk factors are significant (p < 0.05) when the mucosal membranes of the upper airways are impaired (staying in a dusty environment, in smoke-filled rooms, contaminated atmosphere, active smoking, passive smoking) and factors where contact with other people is frequent (overcrowded rooms, multi-generation housing, use of public transport, staying outside the home on brigades, training courses etc.). A risk factor is also lower education of parents which indicates a different lifestyle. Conversely, factors negatively correlated with carriership are favourable economic conditions, frequent outdoor stay and active participation in sports. By comparison of factors significantly associated with the development of invasive meningococcal disease or carriership data are assembled for the implementation of effective preventive measures.
Study objective: To characterize the epidemiological situation of pertussis in children under one... more Study objective: To characterize the epidemiological situation of pertussis in children under one year of age in the Czech Republic in 1997-2013. Material and methods: The study cohort consisted of children under one year of age with laboratory confirmed pertussis reported to the communicable disease system from 1997 to 2013. A total of 265 pertussis cases were reported in children under one year of age over the study period. Selected demographic data, need for hospitalization, and vaccination history were evaluated in the study cohort. Results: Children under one year of age have shown a steady upward trend in reported cases of pertussis since the 1990s. The reported incidence of pertussis in this age group was the lowest in 1998 (1.1/100,000 population) and the highest in 2013 (31.3/100,000). In 1997-2013, 265 pertussis cases were reported in children under one year of age, 128 females and 137 males, to the communicable disease system in the Czech Republic. Most of these children, nearly 77%, developed pertussis within the first four months of life. Of the 265 children, 79% were not vaccinated before the onset of the disease and 21% were immunized with at least one dose of pertussis vaccine before developing the disease. As many as 75% of the children with pertussis needed hospitalization. Most of them, nearly 81%, were hospitalized with pertussis in the first four months of life and 90% of them in the first six months of life. Conclusions: In 1997-2013, an upward trend was observed in pertussis cases in children under one year of age. Most children developed the disease within the first four months of life while not vaccinated against pertussis. This fact unambiguously supports the "cocoon" strategy, i.e. vaccination of the closest contacts of the child, and a booster dose at 25 years of age. At the same time, a question arises whether to provide vaccination to pregnant women.
A new epidemiological situation for invasive meningococcal disease developed in the Czech Republi... more A new epidemiological situation for invasive meningococcal disease developed in the Czech Republic in 1993. The investigation of meningococcal noncapsular antigens revealed that the new strain Neisseria meningitidis C:2a:P1.2 (P1.5) is the causative agent. This strain has never been found in the Czech Republic before, at least not since 1973 (Czech meningococci have been sero/subtyped since). The investigation of the relationships by ET-typing revealed that this Neisseria meningitidis C:2a:P1.2 (P1.5) belongs to the ET-37 clone. In spring 1993 this new meningococcal clone caused an unusual increase of morbidity in two districts in one region of the Czech Republic and during the next winter/spring season (1993/1994) it spread to all regions of the country. This new strain causes severe and frequently atypical clinical manifestations, with the highest morbidity and fatality rates in the age group of 15-19 years (20% fatality in 1993).
Results obtained in the first year of active surveillance of serious diseases caused by group A s... more Results obtained in the first year of active surveillance of serious diseases caused by group A streptococci in the Czech Republic carried out within the Strep-EURO project are summarized. From January to December 2003, 28 Czech laboratories referred to the National Institute of Public Health 59 group A streptococcal strains isolated from invasive diseases meeting the Strep-EURO definition. At the same time, clinical-epidemiological data and information on the catchment area population were provided. For 2003, the total morbidity and case fatality rates were calculated to be 1.3/100,000 population and 13.5%, respectively. A high proportion (23.7%) of the 59 strains were of type emm 1, initially labeled M1. As many as 24.1%, 17.2% and 20.7% of the strains tested were resistant to erythromycin, clindamycin and tetracycline, respectively. The seemingly lower morbidity rate and higher case fatality rate from serious diseases caused by group A streptococci reported in the Czech Republic for 1994-1996, i.e. 0.4/100,000 and 46.5%, respectively, in comparison with the latest data can be explained by the use of softer international criteria for the Strep-EURO definition of invasive disease.
In the Czech Republic where meningococcal disease occurred only sporadically for a very long peri... more In the Czech Republic where meningococcal disease occurred only sporadically for a very long period and Neisseria meningitidis B prevailed, the use of a meningococcal polysaccharide vaccine was never indicated. This situation changed in 1993 when a new clone of Neisseria meningitidis C:2a:P1.2(P1.5) appeared in the Czech Republic, found to be responsible for a new epidemiological and clinical situation. The disease caused by this new clone is more serious, showing a high fatality rate (20%) and frequently an atypical clinical course. In May 1993, the highest age-specific incidence in the most affected locality was established in the age group of 15-19 years (52.1/100,000), while in the whole Czech Republic the respective figure was 2.4. A vaccination campaign focusing on the most affected age group started in this locality at the beginning of June 1993, using a polysaccharide meningococcal vaccine A+C (Mérieux). During two weeks 6191 students of the age group of 15-19 years were vaccinated, i.e. 96% of all students of this age group, 64.5% of the population 15-19 years old and 5.6% of the whole population of this locality. This age targeted vaccination prevented the spread of the meningococcal invasive disease caused by Neisseria meningitidis C in this locality. The decrease in morbidity in this locality is statistically highly significant (p < 0.001). In another affected locality, where vaccination was not age targeted and showed a very low coverage, the incidence of the invasive disease caused by Neisseria meningitidis C did not decrease. During the following period (1993-1994) the new meningococcal clone spread to all regions of the Czech Republic. Active surveillance of meningococcal invasive disease has been conducted with the aim to recognize as early as possible an emerging epidemiological indication for targeted vaccination.
In spite of a large collection of MAbs used for the whole-cell ELISA (WCE) in the National Refere... more In spite of a large collection of MAbs used for the whole-cell ELISA (WCE) in the National Reference Laboratory for Meningococcal Infections in Prague 50-80% of N.meningitidis strains isolated in the Czech Republic remained non-typable (NT) and/or non-subtypable (NST). A project focused on the problem of NT/NST N.meningitidis was started and the new serotype candidate designated "22" resulted from this research. This paper presents the method of preparing and testing of the monoclonal antibody (MAb) specific for this new serotype and the first experience acquired from using it. The new serotype-specific MAb is of IgG3 class, does not react with any serotype/subtype reference strains and reacts in WCE with the strain used for its production and with some other NT/NST strains in the dilution 1:1,000. A collection of 97 N.meningitidis B:NT strains isolated from cerebrospinal fluid and/or blood of patients with invasive disease in the Czech Republic since 1973 to 1995 was serotyped using the new serotype "22"-specific MAb and 37 of these strains (38.2%) gave positive WCE result. The total number of 59 N.meningitidis B:NT strains isolated in 1995 from various clinical situations were serotyped and 26 of them (44.1%) were positive with the new serotype "22"-specific MAb. Seven of these N.meningitidis B:NT strains isolated in 1995 from various clinical situations were serotyped and 26 of them (44.1%) were positive with the new serotype "22"-specific MAb. Seven of these N.meningitidis B: "22" strains were isolated from cerebrospinal fluid or blood of patients with invasive meningococcal disease and prevailed in the age group of 0-4 years (5 cases). The significance of the new serotype candidate was underlined recently, when this serotype "22" was recognized in N.meningitidis B strain isolated from a died 10 months old boy. These results indicate the epidemiological and clinical significance of the new serotype candidate "22" in the Czech Republic.
Invasive meningococcal disease, caused mainly by Neisseria meningitidis B, occurred only sporadic... more Invasive meningococcal disease, caused mainly by Neisseria meningitidis B, occurred only sporadically in the Czech Republic for a long period, and the use of meningococcal polysaccharide vaccine was never indicated. This situation changed in 1993, when a new meningococcal clone appeared. By means of sero/subtyping (using Whole Cell ELISA) Neisseria meningitidis C:2a:P1.2(P1.5) was quickly revealed to be the causative agent of this unusual epidemiological situation. ET typing by multilocus enzyme electrophoresis showed the prevalence of the ET-15 electrophoretic type, which belongs to the ET-37 complex. This new clone had never been identified in the Czech Republic at least since 1973. The new clone caused an increase in the incidence of invasive meningococcal disease in the army campuses in the eastern part of the country and two local invasive meningococcal disease outbreaks in civilian population at the beginning of 1993. In May 1993, the highest age-specific incidence in the most affected district was found in the age group of 15-19 years (52.1 per 100,000), while the respective age specific incidence for the whole Czech Republic was 1.9 per 100,000. The vaccination campaign started in the most affected district at the beginning of June 1993 and was focused on the most affected age group, 15-19 years. After this targeted vaccination campaign the number of invasive meningococcal disease decreased in this district statistically significantly. The new clone Neisseria meningitidis C:2a:P1.2(P1.5) is causing not only a new epidemiological situation, but also a new clinical situation, characterized by more serious and frequently atypical courses of invasive meningococcal disease with a high incidence of Waterhouse-Friderichsen syndrome and meningococcal sepsis. A high fatality rate was found for the clone Neisseria meningitidis C:2a:P1.2(P1.5) (20%) compared to the "normal" fatality rate of the "non C" invasive meningococcal disease (8.8%) in 1993. The new clone Neisseria meningitidis C:2a:P1.2(P1.5) spread between 1993 and 1995 to the whole country, nevertheless, to date no similar epidemiological situation was identified, as was that in two districts in spring 1993. A more rapid increase in the age specific morbidity occurred recently in the age group of 1-4 years and in adult age groups as well.
Introduction PERTINENT is a pilot active surveillance system of infants hospitalised with pertuss... more Introduction PERTINENT is a pilot active surveillance system of infants hospitalised with pertussis in six European Union/European Economic Area countries (37 hospitals, seven sites). Aim This observational study aimed to estimate annual pertussis incidence per site from 2016 to 2018 and respective trends between 2017 and 2018. Pertussis cases were described, including their severity. Methods We developed a generic protocol and laboratory guidelines to harmonise practices across sites. Cases were hospitalised infants testing positive for Bordetella pertussis by PCR or culture. Sites collected demographic, clinical, laboratory data, vaccination status, and risk/protective factors. We estimated sites’ annual incidences by dividing case numbers by the catchment populations. Results From December 2015 to December 2018, we identified 469 cases (247 males; 53%). The median age, birthweight and gestational age were 2.5 months (range: 0–11.6; interquartile range (IQR): 2.5), 3,280 g (range:...
Prezentována je kazuistika 25letého dosud zdravého muže s horečnatým onemocněním provázeným otoky... more Prezentována je kazuistika 25letého dosud zdravého muže s horečnatým onemocněním provázeným otoky kloubů, bolestmi svalů levého předloktí a s výsevem petechií na kůži v téže oblasti. Stav byl zprvu hodnocen jako flegmóna levého předloktí a empiricky byla zahájena léčba klindamycinem. Pro rozvoj sepse a septického šoku s projevy DIC byl 2. den hospitalizace převzat na JIP oddělení, léčba byla empiricky posílena ceftriaxonem. Nadále se šířily bolesti svalů provázené jejich edémem a zarudnutím kůže nad nimi. Vzhledem k neznámému původci onemocnění byla odeslána krev na PCR vyšetření a komerčním multiplexem byla zachycena Neisseria meningitidis. Sonografickým vyšetřením byly verifikovány zánětlivé změny v postižených svalových skupinách a stav byl uzavřen jako pyomyositida. Na levém předloktí se vyvinula nekróza kůže, která byla lokálně ošetřována. Pacient byl ve stabilizovaném stavu doléčen na standardním oddělení intravenózně ceftriaxonem až do propuštění 17. den. Vzorek krve a punkce z tekutinových kolekcí v postižených svalech byl zaslán ke konfirmaci do národní referenční laboratoře, kde byla metodou real time PCR potvrzena N. meningitidis skupiny C. Klíčová slova: pyomyositida, Neisseria meningitidis skupiny C, metoda PCR, invazivní meningokokové onemocnění. Meningococcal pyomyositis due to Neisseria meningitidis group C in a healthy young man as an unusual form of invasive meningococcal disease A case report is presented of a 25-year-old healthy man with a feverish disease accompanied by joint swelling and pain in the left forearm muscles with petechiae on the skin in the same area. The condition was initially diagnosed as a left forearm phlegmon and treated empirically with clindamycin. Due to the development of sepsis and septic shock with DIC manifestations, on the second day of hospitalization he was referred to the ICU and the antibiotic treatment was strengthened empirically with ceftriaxone. Pain in the muscles continued to spread and was accompanied by their edema and reddening of the skin above them. Because of an unknown disease agent, a blood sample was sent for PCR investigation, where Neisseria meningitidis was detected using a commercial multiplex PCR kit. Ultrasound examination revealed inflammatory changes in the affected muscle groups, and a definitive diagnosis of pyomyositis was made. The patient was transferred to a standard ward in a stabilized state to complete ceftriaxone intravenous antibiotic therapy until discharge on day 17. A blood sample and puncture from fluid collection in the affected muscles were sent for confirmation to the National Reference Laboratory for Meningococcal Infections, where N. meningitidis was confirmed by real time PCR and, subsequently, group C was identified.
In 2001, 730 sera from the population of 14 areas of the Czech Republic aged between 1 and 64 yea... more In 2001, 730 sera from the population of 14 areas of the Czech Republic aged between 1 and 64 years were tested by a microplate assay for the presence of bactericidal antibodies against N. meningitidis A:4,21:P1. 10, N. meningitidis B:2a:P1.2,P1.5 and N. meningitidis C:2a:P1.2,P1.5. The Czech population showed high immunity against N. meningitidis A:4,21:P1.10, but low immunity against N. meningitidis B:2a:P1.2,P1.5 and N. meningitidis C:2a:P1.2,P1.5. The current epidemiological situation requires neither vaccination against meningococcus A nor inclusion of conjugated vaccine against meningococcus C into routine vaccination. Nevertheless, the invasive meningococcal disease surveillance programme needs to be continued since enabling rapid detection of possible changes in the epidemiological situation and subsequent vaccination intervention, if epidemiologically indicated. Conjugated vaccine against meningococcus C should replace polysaccharide vaccine A+C in all indications currently...
Spektrum bakterií, které v České republice působí u dětí hnisavé meningitidy se v průběhu posledn... more Spektrum bakterií, které v České republice působí u dětí hnisavé meningitidy se v průběhu posledních desetiletí změnilo v závislosti na zavádění očkování proti onemocněním způsobeným Streptococcus pneumoniae, Haemophilus influenzae b a Neisseria meningitidis. Tato bakteriální agens před zavedením uvedených očkování převažovala, v současné době se jejich podíl výrazně snížil. Hlášení EPIDAT z roku 2015 ukazují 10 případů hnisavých meningitid u dětí pod 5 let věku, z toho 9 potvrzených případů u dětí pod 1 rok věku, žádný případ nebyl smrtelný. V roce 2015 bylo v programech surveillance zjištěno u dětí pod 5 let věku 21 invazivních pneumokokových onemocnění, 18 invazivních meningokokových onemocnění, jedno invazivní onemocnění způsobené H. influenzae b a dvě invazivní hemofilová non-b onemocnění. Hnisavé meningitidy působené H. influenzae b, pneumokoky a meningokoky jsou preventabilní vakcinací a zde zejména spočívá velmi důležitá úloha pediatra, aby svým působením na rodiče pomáhal udržet, resp. zvyšovat proočkovanost malých dětí proti těmto onemocněním. Klíčová slova: hnisavá meningitida, pneumokoková meningitida, meningokoková meningitida, hemofilová meningitida, očkování. Purulent meningitis in children The spectrum of bacteria causing purulent meningitis in children in the Czech Republic has changed over the last decades, depending on the implementation of vaccination programmes against diseases caused by Streptococcus pneumoniae, Haemophilus influenzae b, and Neisseria meningitidis. Prior to the introduction of the above-mentioned vaccination strategies, these bacterial agents were predominant; recently, their proportion has dramatically decreased. The 2015 EPIDAT (infectious disease reporting system) data show ten cases of purulent meningitis in children under 5 years of age, out of which nine were confirmed in children under 1 year of age, with none of the cases having been fatal. In 2015, surveillance programmes detected, in children under 5 years of age, 21 invasive pneumococcal diseases, 18 invasive meningococcal diseases, one invasive disease caused by H. influenzae b, and two cases of invasive haemophilus non-b disease. Purulent meningitis caused by H. influenzae b, pneumococci, and meningococci are preventable with vaccination, and it is the paediatrician who has a very important role in appealing to parents in order to help maintain and/or increase the vaccination coverage of small infants against these diseases.
Invazivni meningokokove onemocněni je i v době soucasneho pokroku mediciny jednim z nejvice smrti... more Invazivni meningokokove onemocněni je i v době soucasneho pokroku mediciny jednim z nejvice smrticich infekcnich onemocněni, proti němuž je ve větsině evropských zemi doporuceno ockovani. V soucasne době neexistuje univerzalně ucinna vakcina proti vsem seroskupinam meningokoků, jsou vsak již dostupne vakciny, jejichž kombinaci lze dosahnout ochrany proti větsině seroskupin: MenB vakcina a konjugovana tetravakcina A, C, Y, W135. Narodni imunizacni komise jednotlivých zemi aktualizuji doporucenou vakcinacni strategii dle epidemiologicke situace a dle vývoje i dostupnosti nových meningokokových vakcin.
The Global Meningococcal Initiative (GMI) aims to prevent invasive meningococcal disease (IMD) wo... more The Global Meningococcal Initiative (GMI) aims to prevent invasive meningococcal disease (IMD) worldwide through education, research and cooperation. In March 2019, a GMI meeting was held with a multidisciplinary group of experts and representatives from countries within Eastern Europe. Across the countries represented, IMD surveillance is largely in place, with incidence declining in recent decades and now generally at < 1 case per 10 0,0 0 0 persons per year. Predominating serogroups are B and C, followed by A, and cases attributable to serogroups W, X and Y are emerging. Available vaccines differ between countries, are generally not included in immunization programs and provided to high-risk groups only. Available vaccines include both conjugate and polysaccharide vaccines; however, current data and GMI recommendations advocate the use of conjugate vaccines, where possible, due to the ability to interrupt the acquisition of carriage. Ongoing carriage studies are expected to inform vaccine effectiveness and immunization schedules. Additionally, IMD prevention and control should be guided by monitoring outbreak progression and the emergence and international spread of strains and antibiotic resistance through use of genomic analyses and implementation of World Health Organization initiatives. Protection of high-risk * Corresponding author.
SummaryBackgroundThe Invasive Respiratory Infection Surveillance (IRIS) Consortium was establishe... more SummaryBackgroundThe Invasive Respiratory Infection Surveillance (IRIS) Consortium was established to assess the impact of the COVID-19 pandemic on invasive diseases caused byStreptococcus pneumoniae, Haemophilus influenzae, Neisseria meningitidisandStreptococcus agalactiae. Here we analyse the incidence and distribution of disease during the first two years of the pandemic.MethodsLaboratories in 30 countries/territories representing five continents submitted case data from 2018-2021 to private projects within databases in PubMLST. The impact of COVID-19 containment measures on the overall number of cases was analysed, and changes in disease distributions by patient age and serotype/group were examined. Interrupted time series analyses quantified the impact of pandemic response measures and their relaxation on disease rates, and autoregressive integrated moving average models estimated effect sizes and forecasted counterfactual trends by hemisphere.FindingsOverall, 116,841 cases wer...
Národní referenční laboratoř pro meningokokové nákazy Centrum epidemiologie a mikrobiologie, Stát... more Národní referenční laboratoř pro meningokokové nákazy Centrum epidemiologie a mikrobiologie, Státní zdravotní ústav, Praha Invazivní meningokokové onemocnění patří i v době pokroku medicíny mezi nejzávažnější infekční onemocnění s vysokou smrtností a vysokým procentem závažných celoživotních následků u přeživších. Nejlepší prevencí tohoto onemocnění je očkování. Věkově specifická nemocnost invazivního meningokokového onemocnění dětí pod 1 rok věku se v České republice dlouhodobě drží na vysokých hodnotách, druhou a třetí rizikovou skupinou jsou adolescenti ve věku 15-19 roků a děti ve věku 1-4 roky. K očkování proti invazivnímu meningokokovému onemocnění jsou k dispozici v České republice dvě konjugované tetravalentní vakcíny obsahující antigeny čtyř séroskupin meningokoka A, C, W, Y a dvě rekombinantní vakcíny obsahující antigeny meningokoka séroskupiny B (MenB vakcíny). K zajištění co nejkomplexnější imunity proti invazivnímu meningokokovému onemocnění je doporučena kombinace konjugované tetravakcíny A, C, W, Y a MenB vakcíny. Od 1. 1. 2018 je hrazeno očkování proti invazivním meningokokovým infekcím u pojištěnců s poruchami imunity. Od 1. 5. 2020 je očkování malých dětí proti invazivnímu meningokokovému onemocnění zařazeno mezi hrazená očkování. V září 2021 bylo schváleno zařazení očkování i adolescentů proti invazivnímu meningokokovému onemocnění mezi hrazená očkování. Klíčová slova: invazivní meningokokové onemocnění, doporučené očkování, bezplatné očkování, očkování malých dětí, očkování adolescentů, konjugovaná vakcína A, C, W, Y, MenB vakcína. Advances in vaccination against invasive meningococcal disease in the Czech Republic Even at a time of progress in medicine, invasive meningococcal disease is among the most serious infectious diseases with high case fatality rates and a high proportion of severe lifelong consequences in the survivors. Vaccination is the best method of preventing this disease. In the Czech Republic, age-specific morbidity of invasive meningococcal disease in infants under one year of age has long been at high levels, with the second and third risk groups being adolescents aged 15 to 19 years and children aged 1 to 4 years, respectively. For vaccination against invasive meningococcal disease, two tetravalent conjugate vaccines containing antigens of four meningococcal serogroups, A, C, W, and Y, and two recombinant meningococcal vaccines containing serogroup B antigens (MenB vaccines) are available in the Czech Republic. To achieve the broadest possible immunity against invasive meningococcal disease, the combination of conjugate ACWY vaccine and MenB vaccine is recommended. Since 1 January 2018, vaccination against invasive meningococcal infections has been reimbursed for insured persons with immune disorders. Since 1 May 2020, vaccination of young children against invasive meningococcal disease has been fully reimbursed. In September 2021, vaccination of adolescents against invasive meningococcal disease was approved to be included in reimbursed vaccinations.
The nationwide prospective questionnaire study of cases and controls was implemented during the p... more The nationwide prospective questionnaire study of cases and controls was implemented during the period from October 1996 till May 1998. Thirty-nine districts participated (= 54.2% of district hygiene stations) and 107 invasive meningococcal diseases were included in the study (= 76.9% of diseases recorded during the given period in the Czech Republic by active surveillance). A total of 390 subjects were included in the study-107 with invasive meningococcal diseases, 211 healthy controls and 72 healthy carriers of Neisseria meningitidis. This is the first study in the Czech Republic which analyzes comprehensively socioeconomic, health and stress factors in relation to the genesis and development of invasive meningococcal disease or carriership of N. meningitidis. The relationship between these factors and meningococcal disease or carriership was evaluated by the chi square test: odds ratio (OR) and statistical significance (p for chi square-Yates correction or Fischer's exact test). For the development of invasive meningococcal disease in particular, risk factors are significant (p < 0.05) which at the time weaken the overall resistance of the organism: febrile diseases, respiratory diseases, other diseases, exertion, exposure to cold, mental stress, other stress, injury, staying in places outside the home on brigades, training courses, stay in crowded premises. As to long-term factors the development of the disease is influenced by a contaminated environment, passive smoking and lower education of the mother which indicates a different lifestyle. Conversely, factors negatively correlated with the development of the disease are active participation in sports and favourable economic conditions. For death: significant risk factors (p < 0.05) are also factors which weaken the resistance of the organism: exertion, mental stress, other stress (= alcohol consumption), staying outside the home on brigades, training courses etc. For carriership risk factors are significant (p < 0.05) when the mucosal membranes of the upper airways are impaired (staying in a dusty environment, in smoke-filled rooms, contaminated atmosphere, active smoking, passive smoking) and factors where contact with other people is frequent (overcrowded rooms, multi-generation housing, use of public transport, staying outside the home on brigades, training courses etc.). A risk factor is also lower education of parents which indicates a different lifestyle. Conversely, factors negatively correlated with carriership are favourable economic conditions, frequent outdoor stay and active participation in sports. By comparison of factors significantly associated with the development of invasive meningococcal disease or carriership data are assembled for the implementation of effective preventive measures.
Study objective: To characterize the epidemiological situation of pertussis in children under one... more Study objective: To characterize the epidemiological situation of pertussis in children under one year of age in the Czech Republic in 1997-2013. Material and methods: The study cohort consisted of children under one year of age with laboratory confirmed pertussis reported to the communicable disease system from 1997 to 2013. A total of 265 pertussis cases were reported in children under one year of age over the study period. Selected demographic data, need for hospitalization, and vaccination history were evaluated in the study cohort. Results: Children under one year of age have shown a steady upward trend in reported cases of pertussis since the 1990s. The reported incidence of pertussis in this age group was the lowest in 1998 (1.1/100,000 population) and the highest in 2013 (31.3/100,000). In 1997-2013, 265 pertussis cases were reported in children under one year of age, 128 females and 137 males, to the communicable disease system in the Czech Republic. Most of these children, nearly 77%, developed pertussis within the first four months of life. Of the 265 children, 79% were not vaccinated before the onset of the disease and 21% were immunized with at least one dose of pertussis vaccine before developing the disease. As many as 75% of the children with pertussis needed hospitalization. Most of them, nearly 81%, were hospitalized with pertussis in the first four months of life and 90% of them in the first six months of life. Conclusions: In 1997-2013, an upward trend was observed in pertussis cases in children under one year of age. Most children developed the disease within the first four months of life while not vaccinated against pertussis. This fact unambiguously supports the "cocoon" strategy, i.e. vaccination of the closest contacts of the child, and a booster dose at 25 years of age. At the same time, a question arises whether to provide vaccination to pregnant women.
A new epidemiological situation for invasive meningococcal disease developed in the Czech Republi... more A new epidemiological situation for invasive meningococcal disease developed in the Czech Republic in 1993. The investigation of meningococcal noncapsular antigens revealed that the new strain Neisseria meningitidis C:2a:P1.2 (P1.5) is the causative agent. This strain has never been found in the Czech Republic before, at least not since 1973 (Czech meningococci have been sero/subtyped since). The investigation of the relationships by ET-typing revealed that this Neisseria meningitidis C:2a:P1.2 (P1.5) belongs to the ET-37 clone. In spring 1993 this new meningococcal clone caused an unusual increase of morbidity in two districts in one region of the Czech Republic and during the next winter/spring season (1993/1994) it spread to all regions of the country. This new strain causes severe and frequently atypical clinical manifestations, with the highest morbidity and fatality rates in the age group of 15-19 years (20% fatality in 1993).
Results obtained in the first year of active surveillance of serious diseases caused by group A s... more Results obtained in the first year of active surveillance of serious diseases caused by group A streptococci in the Czech Republic carried out within the Strep-EURO project are summarized. From January to December 2003, 28 Czech laboratories referred to the National Institute of Public Health 59 group A streptococcal strains isolated from invasive diseases meeting the Strep-EURO definition. At the same time, clinical-epidemiological data and information on the catchment area population were provided. For 2003, the total morbidity and case fatality rates were calculated to be 1.3/100,000 population and 13.5%, respectively. A high proportion (23.7%) of the 59 strains were of type emm 1, initially labeled M1. As many as 24.1%, 17.2% and 20.7% of the strains tested were resistant to erythromycin, clindamycin and tetracycline, respectively. The seemingly lower morbidity rate and higher case fatality rate from serious diseases caused by group A streptococci reported in the Czech Republic for 1994-1996, i.e. 0.4/100,000 and 46.5%, respectively, in comparison with the latest data can be explained by the use of softer international criteria for the Strep-EURO definition of invasive disease.
In the Czech Republic where meningococcal disease occurred only sporadically for a very long peri... more In the Czech Republic where meningococcal disease occurred only sporadically for a very long period and Neisseria meningitidis B prevailed, the use of a meningococcal polysaccharide vaccine was never indicated. This situation changed in 1993 when a new clone of Neisseria meningitidis C:2a:P1.2(P1.5) appeared in the Czech Republic, found to be responsible for a new epidemiological and clinical situation. The disease caused by this new clone is more serious, showing a high fatality rate (20%) and frequently an atypical clinical course. In May 1993, the highest age-specific incidence in the most affected locality was established in the age group of 15-19 years (52.1/100,000), while in the whole Czech Republic the respective figure was 2.4. A vaccination campaign focusing on the most affected age group started in this locality at the beginning of June 1993, using a polysaccharide meningococcal vaccine A+C (Mérieux). During two weeks 6191 students of the age group of 15-19 years were vaccinated, i.e. 96% of all students of this age group, 64.5% of the population 15-19 years old and 5.6% of the whole population of this locality. This age targeted vaccination prevented the spread of the meningococcal invasive disease caused by Neisseria meningitidis C in this locality. The decrease in morbidity in this locality is statistically highly significant (p < 0.001). In another affected locality, where vaccination was not age targeted and showed a very low coverage, the incidence of the invasive disease caused by Neisseria meningitidis C did not decrease. During the following period (1993-1994) the new meningococcal clone spread to all regions of the Czech Republic. Active surveillance of meningococcal invasive disease has been conducted with the aim to recognize as early as possible an emerging epidemiological indication for targeted vaccination.
In spite of a large collection of MAbs used for the whole-cell ELISA (WCE) in the National Refere... more In spite of a large collection of MAbs used for the whole-cell ELISA (WCE) in the National Reference Laboratory for Meningococcal Infections in Prague 50-80% of N.meningitidis strains isolated in the Czech Republic remained non-typable (NT) and/or non-subtypable (NST). A project focused on the problem of NT/NST N.meningitidis was started and the new serotype candidate designated "22" resulted from this research. This paper presents the method of preparing and testing of the monoclonal antibody (MAb) specific for this new serotype and the first experience acquired from using it. The new serotype-specific MAb is of IgG3 class, does not react with any serotype/subtype reference strains and reacts in WCE with the strain used for its production and with some other NT/NST strains in the dilution 1:1,000. A collection of 97 N.meningitidis B:NT strains isolated from cerebrospinal fluid and/or blood of patients with invasive disease in the Czech Republic since 1973 to 1995 was serotyped using the new serotype "22"-specific MAb and 37 of these strains (38.2%) gave positive WCE result. The total number of 59 N.meningitidis B:NT strains isolated in 1995 from various clinical situations were serotyped and 26 of them (44.1%) were positive with the new serotype "22"-specific MAb. Seven of these N.meningitidis B:NT strains isolated in 1995 from various clinical situations were serotyped and 26 of them (44.1%) were positive with the new serotype "22"-specific MAb. Seven of these N.meningitidis B: "22" strains were isolated from cerebrospinal fluid or blood of patients with invasive meningococcal disease and prevailed in the age group of 0-4 years (5 cases). The significance of the new serotype candidate was underlined recently, when this serotype "22" was recognized in N.meningitidis B strain isolated from a died 10 months old boy. These results indicate the epidemiological and clinical significance of the new serotype candidate "22" in the Czech Republic.
Invasive meningococcal disease, caused mainly by Neisseria meningitidis B, occurred only sporadic... more Invasive meningococcal disease, caused mainly by Neisseria meningitidis B, occurred only sporadically in the Czech Republic for a long period, and the use of meningococcal polysaccharide vaccine was never indicated. This situation changed in 1993, when a new meningococcal clone appeared. By means of sero/subtyping (using Whole Cell ELISA) Neisseria meningitidis C:2a:P1.2(P1.5) was quickly revealed to be the causative agent of this unusual epidemiological situation. ET typing by multilocus enzyme electrophoresis showed the prevalence of the ET-15 electrophoretic type, which belongs to the ET-37 complex. This new clone had never been identified in the Czech Republic at least since 1973. The new clone caused an increase in the incidence of invasive meningococcal disease in the army campuses in the eastern part of the country and two local invasive meningococcal disease outbreaks in civilian population at the beginning of 1993. In May 1993, the highest age-specific incidence in the most affected district was found in the age group of 15-19 years (52.1 per 100,000), while the respective age specific incidence for the whole Czech Republic was 1.9 per 100,000. The vaccination campaign started in the most affected district at the beginning of June 1993 and was focused on the most affected age group, 15-19 years. After this targeted vaccination campaign the number of invasive meningococcal disease decreased in this district statistically significantly. The new clone Neisseria meningitidis C:2a:P1.2(P1.5) is causing not only a new epidemiological situation, but also a new clinical situation, characterized by more serious and frequently atypical courses of invasive meningococcal disease with a high incidence of Waterhouse-Friderichsen syndrome and meningococcal sepsis. A high fatality rate was found for the clone Neisseria meningitidis C:2a:P1.2(P1.5) (20%) compared to the "normal" fatality rate of the "non C" invasive meningococcal disease (8.8%) in 1993. The new clone Neisseria meningitidis C:2a:P1.2(P1.5) spread between 1993 and 1995 to the whole country, nevertheless, to date no similar epidemiological situation was identified, as was that in two districts in spring 1993. A more rapid increase in the age specific morbidity occurred recently in the age group of 1-4 years and in adult age groups as well.
Introduction PERTINENT is a pilot active surveillance system of infants hospitalised with pertuss... more Introduction PERTINENT is a pilot active surveillance system of infants hospitalised with pertussis in six European Union/European Economic Area countries (37 hospitals, seven sites). Aim This observational study aimed to estimate annual pertussis incidence per site from 2016 to 2018 and respective trends between 2017 and 2018. Pertussis cases were described, including their severity. Methods We developed a generic protocol and laboratory guidelines to harmonise practices across sites. Cases were hospitalised infants testing positive for Bordetella pertussis by PCR or culture. Sites collected demographic, clinical, laboratory data, vaccination status, and risk/protective factors. We estimated sites’ annual incidences by dividing case numbers by the catchment populations. Results From December 2015 to December 2018, we identified 469 cases (247 males; 53%). The median age, birthweight and gestational age were 2.5 months (range: 0–11.6; interquartile range (IQR): 2.5), 3,280 g (range:...
Prezentována je kazuistika 25letého dosud zdravého muže s horečnatým onemocněním provázeným otoky... more Prezentována je kazuistika 25letého dosud zdravého muže s horečnatým onemocněním provázeným otoky kloubů, bolestmi svalů levého předloktí a s výsevem petechií na kůži v téže oblasti. Stav byl zprvu hodnocen jako flegmóna levého předloktí a empiricky byla zahájena léčba klindamycinem. Pro rozvoj sepse a septického šoku s projevy DIC byl 2. den hospitalizace převzat na JIP oddělení, léčba byla empiricky posílena ceftriaxonem. Nadále se šířily bolesti svalů provázené jejich edémem a zarudnutím kůže nad nimi. Vzhledem k neznámému původci onemocnění byla odeslána krev na PCR vyšetření a komerčním multiplexem byla zachycena Neisseria meningitidis. Sonografickým vyšetřením byly verifikovány zánětlivé změny v postižených svalových skupinách a stav byl uzavřen jako pyomyositida. Na levém předloktí se vyvinula nekróza kůže, která byla lokálně ošetřována. Pacient byl ve stabilizovaném stavu doléčen na standardním oddělení intravenózně ceftriaxonem až do propuštění 17. den. Vzorek krve a punkce z tekutinových kolekcí v postižených svalech byl zaslán ke konfirmaci do národní referenční laboratoře, kde byla metodou real time PCR potvrzena N. meningitidis skupiny C. Klíčová slova: pyomyositida, Neisseria meningitidis skupiny C, metoda PCR, invazivní meningokokové onemocnění. Meningococcal pyomyositis due to Neisseria meningitidis group C in a healthy young man as an unusual form of invasive meningococcal disease A case report is presented of a 25-year-old healthy man with a feverish disease accompanied by joint swelling and pain in the left forearm muscles with petechiae on the skin in the same area. The condition was initially diagnosed as a left forearm phlegmon and treated empirically with clindamycin. Due to the development of sepsis and septic shock with DIC manifestations, on the second day of hospitalization he was referred to the ICU and the antibiotic treatment was strengthened empirically with ceftriaxone. Pain in the muscles continued to spread and was accompanied by their edema and reddening of the skin above them. Because of an unknown disease agent, a blood sample was sent for PCR investigation, where Neisseria meningitidis was detected using a commercial multiplex PCR kit. Ultrasound examination revealed inflammatory changes in the affected muscle groups, and a definitive diagnosis of pyomyositis was made. The patient was transferred to a standard ward in a stabilized state to complete ceftriaxone intravenous antibiotic therapy until discharge on day 17. A blood sample and puncture from fluid collection in the affected muscles were sent for confirmation to the National Reference Laboratory for Meningococcal Infections, where N. meningitidis was confirmed by real time PCR and, subsequently, group C was identified.
In 2001, 730 sera from the population of 14 areas of the Czech Republic aged between 1 and 64 yea... more In 2001, 730 sera from the population of 14 areas of the Czech Republic aged between 1 and 64 years were tested by a microplate assay for the presence of bactericidal antibodies against N. meningitidis A:4,21:P1. 10, N. meningitidis B:2a:P1.2,P1.5 and N. meningitidis C:2a:P1.2,P1.5. The Czech population showed high immunity against N. meningitidis A:4,21:P1.10, but low immunity against N. meningitidis B:2a:P1.2,P1.5 and N. meningitidis C:2a:P1.2,P1.5. The current epidemiological situation requires neither vaccination against meningococcus A nor inclusion of conjugated vaccine against meningococcus C into routine vaccination. Nevertheless, the invasive meningococcal disease surveillance programme needs to be continued since enabling rapid detection of possible changes in the epidemiological situation and subsequent vaccination intervention, if epidemiologically indicated. Conjugated vaccine against meningococcus C should replace polysaccharide vaccine A+C in all indications currently...
Spektrum bakterií, které v České republice působí u dětí hnisavé meningitidy se v průběhu posledn... more Spektrum bakterií, které v České republice působí u dětí hnisavé meningitidy se v průběhu posledních desetiletí změnilo v závislosti na zavádění očkování proti onemocněním způsobeným Streptococcus pneumoniae, Haemophilus influenzae b a Neisseria meningitidis. Tato bakteriální agens před zavedením uvedených očkování převažovala, v současné době se jejich podíl výrazně snížil. Hlášení EPIDAT z roku 2015 ukazují 10 případů hnisavých meningitid u dětí pod 5 let věku, z toho 9 potvrzených případů u dětí pod 1 rok věku, žádný případ nebyl smrtelný. V roce 2015 bylo v programech surveillance zjištěno u dětí pod 5 let věku 21 invazivních pneumokokových onemocnění, 18 invazivních meningokokových onemocnění, jedno invazivní onemocnění způsobené H. influenzae b a dvě invazivní hemofilová non-b onemocnění. Hnisavé meningitidy působené H. influenzae b, pneumokoky a meningokoky jsou preventabilní vakcinací a zde zejména spočívá velmi důležitá úloha pediatra, aby svým působením na rodiče pomáhal udržet, resp. zvyšovat proočkovanost malých dětí proti těmto onemocněním. Klíčová slova: hnisavá meningitida, pneumokoková meningitida, meningokoková meningitida, hemofilová meningitida, očkování. Purulent meningitis in children The spectrum of bacteria causing purulent meningitis in children in the Czech Republic has changed over the last decades, depending on the implementation of vaccination programmes against diseases caused by Streptococcus pneumoniae, Haemophilus influenzae b, and Neisseria meningitidis. Prior to the introduction of the above-mentioned vaccination strategies, these bacterial agents were predominant; recently, their proportion has dramatically decreased. The 2015 EPIDAT (infectious disease reporting system) data show ten cases of purulent meningitis in children under 5 years of age, out of which nine were confirmed in children under 1 year of age, with none of the cases having been fatal. In 2015, surveillance programmes detected, in children under 5 years of age, 21 invasive pneumococcal diseases, 18 invasive meningococcal diseases, one invasive disease caused by H. influenzae b, and two cases of invasive haemophilus non-b disease. Purulent meningitis caused by H. influenzae b, pneumococci, and meningococci are preventable with vaccination, and it is the paediatrician who has a very important role in appealing to parents in order to help maintain and/or increase the vaccination coverage of small infants against these diseases.
Invazivni meningokokove onemocněni je i v době soucasneho pokroku mediciny jednim z nejvice smrti... more Invazivni meningokokove onemocněni je i v době soucasneho pokroku mediciny jednim z nejvice smrticich infekcnich onemocněni, proti němuž je ve větsině evropských zemi doporuceno ockovani. V soucasne době neexistuje univerzalně ucinna vakcina proti vsem seroskupinam meningokoků, jsou vsak již dostupne vakciny, jejichž kombinaci lze dosahnout ochrany proti větsině seroskupin: MenB vakcina a konjugovana tetravakcina A, C, Y, W135. Narodni imunizacni komise jednotlivých zemi aktualizuji doporucenou vakcinacni strategii dle epidemiologicke situace a dle vývoje i dostupnosti nových meningokokových vakcin.
The Global Meningococcal Initiative (GMI) aims to prevent invasive meningococcal disease (IMD) wo... more The Global Meningococcal Initiative (GMI) aims to prevent invasive meningococcal disease (IMD) worldwide through education, research and cooperation. In March 2019, a GMI meeting was held with a multidisciplinary group of experts and representatives from countries within Eastern Europe. Across the countries represented, IMD surveillance is largely in place, with incidence declining in recent decades and now generally at < 1 case per 10 0,0 0 0 persons per year. Predominating serogroups are B and C, followed by A, and cases attributable to serogroups W, X and Y are emerging. Available vaccines differ between countries, are generally not included in immunization programs and provided to high-risk groups only. Available vaccines include both conjugate and polysaccharide vaccines; however, current data and GMI recommendations advocate the use of conjugate vaccines, where possible, due to the ability to interrupt the acquisition of carriage. Ongoing carriage studies are expected to inform vaccine effectiveness and immunization schedules. Additionally, IMD prevention and control should be guided by monitoring outbreak progression and the emergence and international spread of strains and antibiotic resistance through use of genomic analyses and implementation of World Health Organization initiatives. Protection of high-risk * Corresponding author.
SummaryBackgroundThe Invasive Respiratory Infection Surveillance (IRIS) Consortium was establishe... more SummaryBackgroundThe Invasive Respiratory Infection Surveillance (IRIS) Consortium was established to assess the impact of the COVID-19 pandemic on invasive diseases caused byStreptococcus pneumoniae, Haemophilus influenzae, Neisseria meningitidisandStreptococcus agalactiae. Here we analyse the incidence and distribution of disease during the first two years of the pandemic.MethodsLaboratories in 30 countries/territories representing five continents submitted case data from 2018-2021 to private projects within databases in PubMLST. The impact of COVID-19 containment measures on the overall number of cases was analysed, and changes in disease distributions by patient age and serotype/group were examined. Interrupted time series analyses quantified the impact of pandemic response measures and their relaxation on disease rates, and autoregressive integrated moving average models estimated effect sizes and forecasted counterfactual trends by hemisphere.FindingsOverall, 116,841 cases wer...
Národní referenční laboratoř pro meningokokové nákazy Centrum epidemiologie a mikrobiologie, Stát... more Národní referenční laboratoř pro meningokokové nákazy Centrum epidemiologie a mikrobiologie, Státní zdravotní ústav, Praha Invazivní meningokokové onemocnění patří i v době pokroku medicíny mezi nejzávažnější infekční onemocnění s vysokou smrtností a vysokým procentem závažných celoživotních následků u přeživších. Nejlepší prevencí tohoto onemocnění je očkování. Věkově specifická nemocnost invazivního meningokokového onemocnění dětí pod 1 rok věku se v České republice dlouhodobě drží na vysokých hodnotách, druhou a třetí rizikovou skupinou jsou adolescenti ve věku 15-19 roků a děti ve věku 1-4 roky. K očkování proti invazivnímu meningokokovému onemocnění jsou k dispozici v České republice dvě konjugované tetravalentní vakcíny obsahující antigeny čtyř séroskupin meningokoka A, C, W, Y a dvě rekombinantní vakcíny obsahující antigeny meningokoka séroskupiny B (MenB vakcíny). K zajištění co nejkomplexnější imunity proti invazivnímu meningokokovému onemocnění je doporučena kombinace konjugované tetravakcíny A, C, W, Y a MenB vakcíny. Od 1. 1. 2018 je hrazeno očkování proti invazivním meningokokovým infekcím u pojištěnců s poruchami imunity. Od 1. 5. 2020 je očkování malých dětí proti invazivnímu meningokokovému onemocnění zařazeno mezi hrazená očkování. V září 2021 bylo schváleno zařazení očkování i adolescentů proti invazivnímu meningokokovému onemocnění mezi hrazená očkování. Klíčová slova: invazivní meningokokové onemocnění, doporučené očkování, bezplatné očkování, očkování malých dětí, očkování adolescentů, konjugovaná vakcína A, C, W, Y, MenB vakcína. Advances in vaccination against invasive meningococcal disease in the Czech Republic Even at a time of progress in medicine, invasive meningococcal disease is among the most serious infectious diseases with high case fatality rates and a high proportion of severe lifelong consequences in the survivors. Vaccination is the best method of preventing this disease. In the Czech Republic, age-specific morbidity of invasive meningococcal disease in infants under one year of age has long been at high levels, with the second and third risk groups being adolescents aged 15 to 19 years and children aged 1 to 4 years, respectively. For vaccination against invasive meningococcal disease, two tetravalent conjugate vaccines containing antigens of four meningococcal serogroups, A, C, W, and Y, and two recombinant meningococcal vaccines containing serogroup B antigens (MenB vaccines) are available in the Czech Republic. To achieve the broadest possible immunity against invasive meningococcal disease, the combination of conjugate ACWY vaccine and MenB vaccine is recommended. Since 1 January 2018, vaccination against invasive meningococcal infections has been reimbursed for insured persons with immune disorders. Since 1 May 2020, vaccination of young children against invasive meningococcal disease has been fully reimbursed. In September 2021, vaccination of adolescents against invasive meningococcal disease was approved to be included in reimbursed vaccinations.
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