Data-driven case fatality rate estimation for the primary lineage of SARS-CoV-2 in Poland.

After more than one and a half year since the COVID-19 pandemics outbreak the scientific world is constantly trying to understand its dynamics. In this paper of the case fatality rates (CFR) for COVID-19 we study the historic data regarding mortality in Poland during the first six months of pandemic, when no SARS-CoV-2 variants of concern were present among infected. To this end, we apply competing risk models to perform both uni- and multivariate analyses on specific subpopulations selected by different factors including the key indicators: age, sex, hospitalization. The study explores the case fatality rate to find out its decreasing trend in time. Furthermore, we describe the differences in mortality among hospitalized and other cases indicating a sudden increase of mortality among hospitalized cases at the end of the 2020 spring season. Exploratory and multivariate analysis revealed the real impact of each variable and besides the expected factors indicating increased mortality (age, comorbidities) we track more non-obvious indicators. Recent medical care as well as the identification of the source contact, independently of the comorbidities, significantly impact an individual mortality risk. As a result, the study provides a twofold insight into the COVID-19 mortality in Poland. On one hand we explore mortality in different groups with respect to different variables, on the other we indicate novel factors that may be crucial in reducing mortality. The later can be coped, e.g. by more efficient contact tracing and proper organization and management of the health care system to accompany those who need medical care independently of comorbidities or COVID-19 infection.

Reversed urban-rural gradient in COVID-19 seroprevalence and related factors in a nationally representative survey, Poland, 29 March to 14 May 2021.

BackgroundWe anticipated that people in rural areas and small towns with lower population density, lower connectivity and jobs less dependent on social interaction will be less exposed to COVID-19. Still, other variables correlated with socioeconomic inequalities may have a greater impact on transmission.AimWe investigated how COVID-19 affected rural and urban communities in Poland, focussing on the most exposed groups and disparities in SARS-CoV-2 transmission.MethodsA random digit dial sample of Polish adults stratified by region and age was drawn from 29 March to 14 May 2021. Serum samples were tested for anti-S1 and anti-N IgG antibodies, and positive results in both assays were considered indicative of past infection. Seroprevalence estimates were weighted to account for non-response. Adjusted odds ratios (AORs) were calculated using multivariable logistic regression.ResultsThere was serological evidence of infection in 32.2% (95% CI: 30.2-34.4) of adults in rural areas/small towns (< 50,000 population) and 26.6% (95% CI: 24.9-28.3) in larger cities. Regional SARS-CoV-2 seroprevalence ranged from 23.4% (95% CI: 18.3-29.5) to 41.0% (95% CI: 33.5-49.0) and was moderately positively correlated (R = 0.588; p = 0.017; n = 16) with the proportion of respondents living in rural areas or small cities. Upon multivariable adjustment, both men (AOR = 1.60; 95% CI: 1.09-2.35) and women (AOR = 2.26; 95% CI: 1.58-3.21) from these areas were more likely to be seropositive than residents of larger cities.ConclusionsWe found an inverse urban-rural gradient of SARS-CoV-2 infections during early stages of the COVID-19 pandemic in Poland and suggest that vulnerabilities of populations living in rural areas need to be addressed.

Hepatitis B in Poland in 2021.

Objective: Evaluation of the epidemiological situation of hepatitis B in Poland in 2021 compared to previous years, considering the impact of the COVID-19 pandemic. Material and methods: Data from individual reports on hepatitis B cases and HBV infections registered by local sanitary and epidemiological stations in the EpiBaza system were analyzed. Aggregate data published in the annual bulletins: "Infectious diseases and poisonings in Poland", "Vaccinations in Poland" and data on deaths provided by the Demographic Surveys Department of Statistics Poland (GUS) were also used. Results: In 2021, a total of 1,547 cases of hepatitis B were registered, including 10 cases of acute hepatitis B, with an incidence of acute hepB 0.03/100,000 population. The incidence of acute hepB was lower by 25% than in 2020 and lower by 75% than the median incidence for 2015-2019. Acute cases occurred only in 6 voivodeships, all in people over 28 years of age. Two out of 10 acute cases were classified as imported. In 2021, 1,537 chronic or unknown-phase cases (UNK) were reported and registered, the diagnosis rate was 4.03/100,000 and was higher by 58% than the rate in 2020 and lower by 53% than the median for 2015-2019. The distribution of cases by gender, age and place of residence was similar to that observed previously - chronic cases or UNK were diagnosed more often in men (male-to female ratio 1.5:1) and people living in cities. Two chronic infections have been reported in infants born to HBV-infected women. 2.5% of chronic and UNK cases were considered imported. According to Statistics Poland (GUS), 20 people died in 2021, including 3 due to acute hepatitis B. The vaccination coverage of 1-year-olds with 3 doses of hepatitis B vaccine (HepB3) decreased slightly compared to 2020 and amounted to 89.3%. Conclusions: In the second year of the COVID-19 pandemic, a gradual levelling of the sharp decline in the number of diagnosed chronic and UNK cases that occurred in 2020 was observed. In acute cases, a further decline in incidence was noted compared to 2020, but a smaller number of acute cases was most likely due to the lower effectiveness of surveillance during the COVID-19 pandemic, rather than from an improvement in the epidemiological situation. The vaccination coverage of children in the second year of life (born in 2020) with the third dose of HepB vaccine continued to decline, although slightly.

Hepatitis C in Poland in 2021.

Background: In 2021, the COVID-19 pandemic continued, however, due to the implementation of vaccination, fewer disruptions were observed in healthcare. In the detection of HCV - inextricably linked to access to testing - there was an incomplete return to the pre-pandemic level of diagnostics (in the EU/EEA in 2021, 4.1 infections/100,000, in 2019 - 8.8). The aim of the article was to present the HCV situation in 2021 according to the data of the epidemiological surveillance in Poland compared to 2015-2020. Material and methods: We used the data: 1) from individual epidemiological surveillance; 2) from bulletins for the years 2015-2021 (diagnosis rates) and 3) regarding deaths from the Statistics Poland, Demographic Surveys and Labour Market Department. Results: In 2021, a 30% increase in the detection of new HCV infections was observed (3.26/100,000, 1,244 cases) - about 70%, more than 2,500 cases, are missing to return to the pre-pandemic level. The demographic distribution was different than in Europe: 1) the ratio of women to men 1:1.07; 2) people <25 years: 2.4% of all diagnoses - this may imply worse access to testing among men than women (tested during pregnancy), especially in younger age groups. In Poland, a large percentage of diagnoses involves people outside the high- risk population - mainly exposures related to medical procedures (>75%). The role of primary health care in diagnosing HCV has strengthened (38.6%) - despite the fact that the tests were not yet available within health insurance benefits. The burden on healthcare and sanitary inspection continued to reduce the quality of data. There were more deaths due to acute hepatitis C in 2020-2021 (4 and 6 cases) compared to 2018 2019 (0 and 1 death). Conclusions: The highlighted gaps in diagnosing HCV infections in Poland should be taken into consideration while developing the policy for HCV infections elimination. Poland still lacks in long term solutions, acceptable by and reaching the target population.

Hepatitis of unknown aetiology in children - epidemiological overview of cases reported in Europe, 1 January to 16 June 2022.

Following the report of an excess in paediatric cases of severe acute hepatitis of unknown aetiology by the United Kingdom (UK) on 5 April 2022, 427 cases were reported from 20 countries in the World Health Organization European Region to the European Surveillance System TESSy from 1 January 2022 to 16 June 2022. Here, we analysed demographic, epidemiological, clinical and microbiological data available in TESSy. Of the reported cases, 77.3% were 5 years or younger and 53.5% had a positive test for adenovirus, 10.4% had a positive RT-PCR for SARS-CoV-2 and 10.3% were coinfected with both pathogens. Cases with adenovirus infections were significantly more likely to be admitted to intensive care or high-dependency units (OR = 2.11; 95% CI: 1.18-3.74) and transplanted (OR = 3.36; 95% CI: 1.19-9.55) than cases with a negative test result for adenovirus, but this was no longer observed when looking at this association separately between the UK and other countries. Aetiological studies are needed to ascertain if adenovirus plays a role in this possible emergence of hepatitis cases in children and, if confirmed, the mechanisms that could be involved.

Hepatitis B in Poland in 2020.

OBJECTIVE: Aim of the study was the assessment of hepatitis B epidemiological situation in Poland in 2019 compared to previous years, taking into consideration the impact of the COVID-19 pandemic during that time. MATERIAL AND METHODS: Data for 2020 included in individual reports on hepatitis B and HBV infections recorded by sanitary and epidemiological stations at EpiBaza, i.e. in the electronic epidemiological surveillance system on infectious diseases, were analyzed. In the assessment of the epidemiological situation, data published in the annual bulletins: "Infectious diseases and poisonings in Poland in 2020" and "Vaccinations in Poland in 2020" were also used. Data on deaths were obtained from the Statistics Poland (GUS). RESULTS: In 2020, 2,854 cases of hepatitis B were reported, which corresponds to the incidence of 2.59 per 100,000 population, lower by 65.1% than in 2019. 14 cases of acute hepatitis B were reported, constituting 1.4% of all registered cases. The incidence of acute hepatitis B was 0.04 per 100,000 population and was lower by 67% compared to 2019 and lower by 71% compared to the median for the years 2014-2018. There were no cases of acute disease in the age group 0-29 years. A total of 978 chronic and unknown hepatitis B cases (UNK) were registered and the diagnosis rate was 2.56 per 100,000 population, lower by 64.2% than in 2019. Compared to the median diagnosis rate of chronic hepatitis B in 2014-2018, a decrease of 70.4% was observed. In the age group 0-19 years, there was no case reported. In 2020, 24 people died due to hepatitis B, including 22 from chronic hepatitis B. CONCLUSIONS: The COVID-19 pandemic resulted in a significant reduction in the number of HBV tests performed and, consequently, a reduction in the number of diagnosed infections. A decrease in the number of detected infections was observed from the second quarter of 2020, i.e. from the beginning of the COVID-19 pandemic, although already in the first quarter of 2020 the number of registered hepatitis B cases was lower than in the same period in 2019. No acute cases were reported among people who were vaccinated against hepatitis B during childhood. Vaccination with three doses of hepatitis B vaccine in children in the second year of life was only slightly lower than in 2019, which proves the stability of the implementation of the preventive vaccination program, despite the limited access to primary health care during the pandemic.

Hepatitis C in Poland in 2020.

BACKGROUND: The year 2020 in the extent of HCV infection was set for the first milestones on the road to the eradication of HCV infection in 2030. In addition, in 2020 there was a global public health crisis - the COVID-19 pandemic. The aim of this paper was to assess the epidemiological situation of HCV infection based on epidemiological surveillance data in Poland in 2020. MATERIAL AND METHODS: Analysis of: 1) individual data from surveillance in 2020 conducted by EpiBaza system; 2) diagnosis rate from bulletins "Infectious diseases and poisonings in Poland" for the years 2014-2020; and 3) data about deaths due to hepatitis C from the Demographic Surveys and Labour Market Department of Statistics Poland. RESULTS: In 2020, there was a significant decrease in the number of reported cases and thus in the diagnosis rate of HCV infection in Poland - 955 HCV infections were reported (2.49/100,000 - in comparison with 2019, 3.5 times less). The decrease occurred in all voivodeships (ranging from 0.50 to 6.37/100,000), we observe more districts in which HCV infections were not detected (in 2020 - 35.3%; in 2019 - 16.8%). The diagnosis rate of HCV infection in women and men was at a similar level. However, large disproportions are visible if age groups are considered in addition to gender. For years, we have observed a variation of the diagnosis rate of HCV infection depending on the environment of residence - also in 2020, higher values were reported overall in residents of urban than in rural areas (2.90 vs. 1.88/100,000). In 2.9% of newly diagnosed HCV infections, at the same time cirrhosis was already present, 0.4% had liver failure, and 0.1% had hepatocellular carcinoma. Among exposures of HCV infection, those related to nosocomial transmission still dominate (59%), also in acute hepatitis C (60%). One-third of reported infections were diagnosed in primary health care, and one in four were diagnosed during hospitalization. CONCLUSIONS: The data presented in this paper show that the COVID-19 pandemic deepened the inequalities observed for years in HCV areas. Establishing a diverse system of testing and linking to care in Poland, reaching those in the greatest risk of ongoing transmission of HCV infection, and providing methodologically correct studies to assess progress in the eradication of HCV infection is becoming increasingly urgent to achieve the planned 2030 WHO targets.

Hepatitis B in Poland in 2019.

OBJECTIVE: Assessment of hepatitis B epidemiological situation in Poland in 2019 compared to previous years. MATERIAL AND METHODS: Data on the incidence of hepatitis B and HBV infections from 2019 registered by sanitary and epidemiological stations in the electronic Epidemiological Interview Registration System in Poland were analyzed. Data from the published annual bulletins: "Infectious diseases and poisonings in Poland" and "Vaccinations in Poland" were also used. Data on deaths were obtained from the Central Statistical Office. RESULTS: In 2019, 2,854 cases of hepatitis B were reported, which corresponds to the incidence of 7.4 per 100,000 population. Acute cases accounted for 1.6% of all registered cases. The incidence of acute hepatitis B was higher by 20% than in 2018 and lower by 20% than the median incidence for 2013-2017. There were no acute cases among children and adolescents aged 0-19 years. In the age group 20-24, 1 case was reported. The incidence of chronic and unknown stage of hepatitis B was lower by 11% than in the previous year, however, compared to the median incidence of chronic hepatitis B in 2013-2017, it was lower by 15%. As in previous years, acute, chronic and unknown infections occurred more often among men than among women, and more often among urban than rural residents. The most common and probable routes of HBV infections were medical procedures, which accounted for 75% of cases with a known route of transmission. In 2019, the HBV vaccination coverage with the third vaccine dose in children born in 2018 was 90.5%, which is less than in previous year. In 2019, 29 people died due to hepatitis B, including one as a result of an acute infection. CONCLUSIONS: The incidence of hepatitis B in Poland over the years (2015-2019) has a decreasing tendency. Among people covered by universal HBV vaccinations, born after 1994, no acute cases were reported. However, the decrease in newborns and infants vaccination coverage may cause the increased risk of new HBV infections, even in the people subject to compulsory vaccinations against hepatitis B. Changes introduced in the surveillance system on hepatitis B in 2014 allow for the levelling of territorial discrepancies in the hepatitis B registered cases and allow for the assessment of the actual number of newly detected HBV infections. The persistence of the low incidence of acute hepatitis B indicates the need to maintain the preventive measures applied so far, in particular the universal compulsory vaccinations of newborns and recommending vaccinations to all previously unvaccinated people.

Hepatitis C in Poland in 2019.

BACKGROUND: HCV infection continues to be a significant public health problem in Europe. The aim of the study was to assess the epidemiological situation of hepatitis C in Poland in 2019, based on data collected as part of epidemiological surveillance in 2019, comparing them to data from previous years. MATERIAL AND METHODS: The following were analyzed: 1) data from epidemiological surveillance in 2019 2) diagnosis rates from "Infectious Diseases and Poisonings in Poland" bulletins for the years 2013-2019 3) data on deaths due to hepatitis C from the Demographic Surveys and Labour Market Department of the Statistics Poland. RESULTS: In 2019, the HCV diagnosis rate was 8.71 per 100 thousand - a total of 3 343 cases of HCV infection were reported. This was a slight decrease compared to 2018. Still we observe the rate differentiation, territorial (differences in the value of the diagnosis rate are noticeable already at the voivodeship and poviat level) and demographic (higher rates in men than in women, higher rates in urban than in rural areas), which is probably related to HCV testing accessibility. Among acute hepatitis C cases according to the EU definition, indicative of current HCV transmission, exposures related to health care (haemodialysis and nosocomial transmission) were identified, followed by non-medical injection (community needle stick injuries, tattoos, piercings) and sexual contact. A low number of diagnoses (5.9%; 196/3343) among people who inject drugs indicate diagnostic difficulties. CONCLUSIONS: For years, the overview of hepatitis C in Poland, observed in epidemiological surveillance, has been determined by the availability of HCV testing. Developing the comfortable testing + treatment system in Poland that reaches people exposed to the current transmission of HCV infection (bearing in mind the possibility of re-infection) is the only possibility of eradication of HCV infections.

Hepatitis B in Poland in 2018.

OBJECTIVE: Evaluation of the epidemiological situation of hepatitis B in Poland in 2018 compared to the situation in previous years. MATERIAL AND METHODS: The epidemiological situation was assessed based on the results of the analysis of individual data on hepatitis B cases and HBV infections registered by Local Sanitary- Epidemiological Stations in the central database using Epidemiological Interview Registration System (SRWE). Aggregate data published in the annual bulletins "Infectious Diseases and Poisonings in Poland" and "Vaccinations in Poland" were also used. RESULTS: In 2018, a total of 3 196 hepatitis B cases were registered, which corresponds to an incidence of 8.3 cases per 100,000 population. Acute hepatitis B cases accounted for about 1.3 % of total. The incidence of acute hepatitis B was lower by 33% than in 2017 and lower by 44% than median of the years 2012-2016. No acute cases were reported among children and adolescents aged 0-19 years and in the age group 20-24. The incidence of chronic and unknown (in terms of the stage) was lower by 4.5% than in the previous year however, in comparison to median incidence of chronic hepatitis B in 2012-2016 an increase of 17% was noted. As in the previous years, acute, chronic and unknown stage (UNK) hepatitis B were more often detected in men and in urban residents. The dominant route of transmission of HBV infections still remains procedures performed in medical settings - 86% of cases with a known transmission route. The coverage with the third HBV vaccine dose in children aged two years was 91 % and remains ( since 2017) below the 95% required in the elimination strategy. In 2018 three people died due to acute hepatitis B and 35 people due to chronic hepatitis B. CONCLUSIONS: In 2018 decrease in the incidence of acute and chronic hepatitis B was observed. In group of persons born after 1994 covered by obligatory hepatitis B vaccinations as newborns no acute cases have been reported, however, a progressive decline in children's vaccination coverage poses a risk for new HBV infection also among people subjected to mandatory vaccinations. Maintenance of a low incidence of acute hepatitis B requires improvement in carrying out of mandatory vaccination among newborns and further recommendation of vaccination for all persons previously unvaccinated. A slight decline in the detection of chronic and UNK cases may be related to the number of tests performed in a given year.

Hepatitis C in Poland in 2018.

OBJECTIVE: Analysis of data on hepatitis C, collected as part of epidemiological surveillance in 2018, compared to previous years. MATERIAL AND METHODS: Analysis of: 1) individual data from surveillance in 2018 2) diagnosis rate from bulletins "Infectious diseases and poisonings in Poland" for the years 2012-2018 and 3) data about deaths due to hepatitis C from the Demographic Surveys and Labour Market Department of the Central Statistical Office. RESULTS: In 2018, there was a decrease in the number of reported hepatitis C cases (3,442 cases) and the diagnosis rate (8.96 per 100,000; taking into account the territorial distribution: from 3.29 per 100,000 in the Podkarpackie voivodeship to 13.69 per 100,00 in the Lubuskie voivodeship). The disproportion of the rates between the sexes returned (in men 9.34 per 100,000 vs. women: 8.61 per 100,000). The disproportion of the diagnosis rate depending on the place of residence was still evident (urban: 10.84 per 100,000 vs. rural: 6.12 per 100,000). There are differences in the values of the diagnosis rates, analyzed in terms of gender, age groups and the place of residence. Based on the EU definition, 14 acute hepatitis C were reported, while according to the PL definition, 88 cases (0.4% and 2.6% of all reported cases, respectively). HCV infections due to medical procedures are still the main route of transmission, also in cases of acute hepatitis C - which indicates the current route of transmission. According to the Demographic Surveys and Labour Market Department of the Central Statistical Office, 119 deaths related to hepatitis C were reported. CONCLUSIONS: For years, the general picture of hepatitis C in Poland, observed through epidemiological surveillance, is determined by the availability of testing for HCV infections. The analysis identified subpopulations in which primary prevention activities (e.g. safer medical procedures, intensifying activities in the area of harm reduction for people who inject drugs) as well as secondary prevention (access to testing and quick inclusion in treatment) should be particularly strengthened. According to the micro-elimination strategy, the improvement of testing in particularly affected groups, including marginalized populations, is necessary to achieve the WHO goal of eliminating HCV by 2030.

COVID-19 module in SRWE system - application and use in epidemiological surveillance and reporting to international institutions.

The new SARS-CoV-2 (Severe Acute Respiratory Syndrome Coronavirus-2) coronavirus causing acute respiratory disease COVID-19 (2019 coronavirus disease) detected in China in 2019 very quickly revealed its epidemic potential and was recognized as a global health problem. The situation caused by the rapidly increasing number of new cases and deaths due to COVID-19 required the rapid development of international recommendations and procedures to limit the spread of infections and ongoing monitoring of the epidemiological situation. In the field of epidemiological surveillance of COVID-19 cases, international organizations - WHO and regionally ECDC, have developed basic requirements for reporting data on newly detected cases of infection. In order to ensure the possibility of reporting new cases and activities undertaken by sanitary-epidemiological services in the country and to fulfill the obligation to report data to the European surveillance network, it was necessary to adapt the electronic system supporting epidemiological surveillance operations, for registration of suspected and confirmed cases of SARS-CoV-2 infections. This work presents the characteristics of the new COVID-19 module created as part of the central Epidemiological Case Reporting System and a preliminary evaluation of its usefulness for the purposes of combating COVID-19. CONCLUSIONS. The Epidemiological Case Reporting System is an efficient and adequate tool that can be adapted to newly emerging threats. In order to use the module to monitor the current epidemiological situation, it is necessary to integrate it with other systems collecting data about COVID-19 patients - ie. EWP and the clinical patient register.

Malaria in Poland in 2014-2018

OBJECTIVE: Assessment of the epidemiological situation of imported malaria in Poland in 2014-2018 in comparison with the situation in previous years. MATERIAL AND METHODS: The analysis of data on malaria cases included in individual reports sent to the Department of Epidemiology of NIPH-NIH by sanitary-epidemiological stations and aggregate data published in annual bulletins "Infectious diseases and poisonings in Poland" was carried out. Reported cases were classified according to the criteria of the case definition applicable in EU countries (2012/506 / EU). RESULTS: In 2014-2018, a total of 141 cases of malaria were registered in Poland, all cases were imported from malaria-endemic countries. The lowest number of cases reported in 2014 (19 cases), and the highest in 2016 (38 cases), the median number of cases in the period 2014-2018 was 28 and was by 27% higher than in the previous 5-year period. The incidence in the observed period was 0.7 per 1 million population and case fatality rate 3.6% (5 deaths per 140 cases with known outcome). Patients were aged 18-74 years, median age was 38 years, males accounted for 72% of all patients. In 89% of cases, infection was acquired in African countries and Cameroon was the most frequently mentioned among countries of exposure. Species of Plasmodium was determined in 90% of invasions, of which P. falciparum accounted for 78%. Most of malaria patients registered in Poland travelled for tourism/leisure (45%, 56/124) or business (43%, 53/124). People visiting the country of origin (visiting friends and relatives, VFR) accounted for 10% of patients for whom the purpose of the trip was known. The mean time of diagnostic delay between the onset of symptoms and the diagnosis was 6 days. CONCLUSIONS: In recent years, there has been an increase in the number of malaria cases in Poland compared to previous years, but the total number of cases remains low. After a few years of low fatality rate, the number of deaths due to malaria increased again, likewise the number of cases with diagnostic delays (> 3 days after the onset of symptoms) and severe disease. The obtained data indicate the need to strengthen activities that raise the awareness of travellers on available prophylaxis and need to remind primary healthcare doctors about an extended anamnesis including travel history and the consideration of malaria in diagnosing of a febrile patient.

Hepatitis B in Poland in 2017

OBJECTIVE: Evaluation of the epidemiological situation of hepatitis B in Poland in 2017 in relation to previous years. MATERIAL AND METHODS: Analysis was carried out on data on hepatitis B and HBV infections registered in the Epidemiological Interview Registration System (SRWE) kept in NIPH-NIH. Aggregate data published in the annual bulletins "Infectious Diseases and Poisonings in Poland" and "Vaccinations in Poland" were also used. RESULTS: In 2017, a total of 3,363 cases of hepatitis B were registered, including 29 cases of HBV and HCV co-infections. The number of acute hepatitis B cases was 56, accounting for 1.7% of all hepatitis B cases. The incidence of acute hepatitis B was 0.15 per 100,000 population. In comparison with 2016 there was a slight increase the incidence of acute hepatitis B (In 2016, incidence was 0.13 per 100,000 population and the number of acute hepatitis B was 50). 887 cases of chronic and 2420 of uknown stage hepatitis B were registered (26.4% and 71.9%, respectively) The incidence of chronic or UNK stages was lower by almost 12% than in previous year. As in previous years, incidence varied a lot at level of voivodeships. The highest incidence was recorded in Pomorskie voivodeship (15 per 100,000). Acute, chronic and unknown stage (UNK) hepatitis B were more often detected in men and in urban residents. In most of HBV cases the probable route of transmission were still medical procedures. In 2017, HBV vaccination coverage in children with the third HBV vaccine dose for the first time in many years decreased below the required 95% in the elimination strategy. CONCLUSIONS: Compared to the previous year a similar number of cases of acute hepatitis B was registered. The good epidemiological situation in the area of acute hepatitis B is mainly the result of effective vaccinations of newborns, however, there has been observed a systematic decline in children's vaccination coverage for several years. Slight annual fluctuations in the number of chronic and UNK cases detected may be related to the number of tests performed in a given year.

Hepatitis C in Poland in 2017

OBJECTIVE: The aim of this article was to analyze the epidemiological situation of HCV in Poland in 2017, based on data collected as part of epidemiological surveillance. MATERIAL AND METHODS: The analysis was carried out based on: 1) individual data collected as part of epidemiological interviews with persons diagnosed with HCV infection in 2017, 2) diagnosis rate from bulletins "Infectious diseases and poisonings in Poland" for the years 2011-2017 and 3) data about deaths due to hepatitis C from the Demographic Surveys and Labour Market Department of the Central Statistical Office. RESULTS: In 2017, the diagnosis rate of HCV infection stayed on high level: 10.44 per 100,000 (4010 cases were reported). Stabilization of hepatitis C epidemiological situation was observed in the following issues: 1) diagnosis rate reported in men and women remained at a similar level (10.55 vs. 10.33 per 100,000); 2) diagnosis rate still showed variation depending on the voivodship (from 4.09 to 18.48 per 100,000) and the location of residence (urban/rural, 12.7 vs. 7.0 per 100,000); 3) the percentage of hospitalization accompanying the new cases of HCV infection has shown downward trend (36% in 2017); 4) the decreasing hepatitis C mortality trend was continued (175 cases of death in 2017); 5) the most common possible transmission route were still medical procedures. In 2017, the outbreak of HCV infection in the Lubelskie was registered. (8 patients, 291 exposed persons, with whom computer tomography with a contrast from multi-dose packaging was conducted, using an automatic injection device). CONCLUSIONS: Epidemiological situation of hepatitis C since 2015 is stable. The role of medical care in the transmission of HCV infections in Poland is worrying.

Significant proportion of acute hepatitis B in Poland in 2010-2014 attributed to hospital transmission: combining surveillance and public registries data.

BACKGROUND: Efficient control of acute hepatitis B requires identification of current transmission routes. Countries in Central-Eastern Europe including Poland attribute an important fraction of cases to nosocomial transmission, as opposed to Western European countries. However, due to possible multiple exposures during the incubation time such assignment may be debatable. This study aimed at assessing of most affected groups and current transmission pattern of acute hepatitis B. METHODS: We investigated exposures reported by acute hepatitis B cases notified to routine surveillance system in Poland in 2010-2014 in comparison to data on hospitalization rates in general population. RESULTS: Hospitalization during incubation time significantly increased the risk of HBV infection (RR 3.13, 95%CI 2.58-3.80). Overall hospitalization population attributable risk (PAR%) was 25.7% (95% CI 20.3%-31.1%) as compared to 35% of acute cases assigned to hospital transmission in surveillance database. PAR% increased from 9.5% (1.12%-17.8%) in the age group 25-34 to 41.1% (28.2% - 53.9%) among those 65 +. In addition, cases < 40 more frequently than the older ones reported history of injecting drugs and risky sexual contacts (25% vs 5%). 27% of men < 40 did not report any exposure at all, drawing attention to possible underreporting of risk behaviors. CONCLUSIONS: The distribution of probable transmission routes differed by age and gender. Further improvement of HBV control requires better coverage of vaccination in risk groups but also strengthening the blood-borne infections control in hospitals.

Hepatitis B in Poland in 2016

OBJECTIVE: Evaluation of the epidemiological situation of hepatitis B in Poland in 2016 compared to the situation in previous years. MATERIAL AND METHODS: The epidemiological situation was assessed based on the results of the analysis of individual data on hepatitis B cases and HBV infections registered by Local Sanitary- Epidemiological Stations in the central database using Epidemiological Interview Registration System (SRWE). Aggregate data published in the annual bulletins "Infectious Diseases and Poisonings in Poland" and "Vaccinations in Poland" were also used. RESULTS: In 2016, a total of 3806 hepatitis B cases were registered, including 21 HBV/HCV co-infections. The number of acute hepatitis B cases was 50 (incidence 0.13 per 100,000 population). In comparison with 2015 there was a slight decrease in both the incidence and contribution of acute cases in the total number of hepatitis B. In people aged 0-20 years, subjected to mandatory vaccinations as neonates, no acute cases have been reported. Most cases of acute hepatitis B occurred probably due to medical procedures (73% of cases with a known transmission route). The incidence of chronic and unknown (in terms of stage) hepatitis B was 9.77 per 100,000 population and it was higher by 8% than in the previous year. The highest incidence was recorded in pomorskie voivodeship (19.42 per 100,000), and the lowest in lubelskie voivodeship (2.81 per 100,000). Chronic and unknown stage (UNK) hepatitis B were more often detected in men (1.3-fold more frequent than in women) and in urban residents (1.5-fold more frequent than in rural). The dominant route of transmission of chronic and UNK infections still remains procedures performed in medical settings (77% of cases with a known transmission route). According to CSO data 4 people died due to acute hepatitis B and 35 people due to chronic hepatitis B in 2016. CONCLUSIONS: In comparison with 2015 the epidemiological situation of hepatitis B did not change significantly - there was a slight increase the incidence of chronic and UNK hepatitis B, may be due to the number of tests performed per year and due to completeness of reporting for surveillance. A high percentage of acute cases related probably to medical procedures points to the need to strengthen compliance with safety rules while performing medical procedures at all levels of care and recommendation of vaccination against hepatitis B for all persons previously unvaccinated.

Hepatitis C in Poland in 2016

INTRODUCTION: In 2016, the World Health Organization implemented a Global Strategy to eliminate viral hepatitis. For Hepatitis C, the goals of this Strategy include increased harm reduction coverage, improved safety of medical procedures and an increase the percentage of people diagnosed and treated. OBJECTIVE: This article aims are evaluating the epidemiological situation of HCV infections in Poland in 2016 in reference to the data from previous years. MATERIAL AND METHODS: Analysis of epidemiological situation of hepatitis C in Poland in 2016 was carried out on case-based data collected through routine surveillance system. Data on hepatitis C mortality from the Demographic Surveys and Labour Market Department of the Central Statistical Office were also included. RESULTS: In 2016, a total of 4,261 cases were reported. Diagnosis rate was 11.09 per 100,000, on the similar level as in 2015 (1% decrease), but in comparison to the median for the years 2010-2014 it increased by 88%. The most common possible route of HCV infection were medical procedures accounting for 69.8% of all cases and for 58.2% of acute hepatitis C virus infection cases. In 2016, 224 deaths due to hepatitis C were registered. In 2016, a hepatitis C outbreak was reported in malopolskie voivodeship (11 patients of the Hemato-oncolology Department, 129 people exposed). CONCLUSIONS: The increase of HCV diagnosis rate, which has been reported for last three years, is probably a consequence of improved the surveillance, including mandatory reporting of positive laboratory results, but also increased availability of HCV laboratory screening. Medical exposures are still an important route of transmission of HCV in Poland.

What weighs more-low compliance with self-deferral or minor medical procedures? Explaining the high rate of hepatitis C virus window-period donations in Poland.

BACKGROUND: Since the introduction of nucleic acid testing (NAT) for routine blood donor screening, hepatitis C virus (HCV) RNA-only detection rates reported from Poland have been higher than in most other European countries. STUDY DESIGN AND METHODS: To examine factors that likely contribute to these window-period donations, we conducted a case-control study among 47 recently HCV-infected blood donors (cases), who gave blood between July 2002 and June 2014, and 141 controls matched by age, sex, and donation dates. Firth-corrected, conditional logistic regression models were fitted to estimate adjusted odds ratios and 95% confidence intervals. Adjusted population-attributable fractions were calculated based on the distribution of exposure among the cases. RESULTS: On multivariate analysis, recent exposures in health care environments not routinely ascertained through predonation questionnaires were strongly associated with recently acquired HCV infection. These exposures included minor medical and dental procedures in the preceding 6 months (adjusted odds ratio, 5.77; 95 % confidence interval, 2.01-18.53). However, based on the population-attributable fraction, more important were behavioral deferrable risks that went unreported at the time of donation, such as high-risk sexual behaviors in the preceding 6 months (population-attributable fraction, 34%) or lifetime histories of drug use (population-attributable fraction, 28%). CONCLUSIONS: This study raises questions about the effectiveness of deferral policy in excluding high-risk individuals. In addition, it provides further evidence supporting short, temporal deferrals for small medical procedures and dental treatments in Poland.

Hepatitis B in Poland in 2015

OBJECTIVE: Assessment of the epidemiological situation of hepatitis B in Poland in 2015 in relation to previous years. MATERIAL AND METHODS: Evaluation of the epidemiological situation carried out based on analysis of data from individual reports on acute hepatitis B cases registered by the sanitary-epidemiological stations, aggregate data published in annual bulletins "Infectious diseases and poisonings in Poland" and data from annual bulletin "Vaccinations in Poland". RESULTS: In total, 3 518 cases of hepatitis B were registered in 2015, including 24 cases of HBV/ HCV co-infections. Acute cases accounted for 1.5% of all recorded cases, with a sustained downward trend in incidence - 0.14 per 100,000. Incidence of acute hepatitis B was lower by 22% compared to the previous year. In group of children up to 14 years old, covered by universal vaccinations of neonates, 1 acute case was reported in a 4-month-old child. Most of acute hepatitis B infections (58%) were probably acquired during medical procedures performed in health care settings. The number of chronic and unknown (in terms of stage) cases registered increased in comparison with the previous year, the incidence was 9.0 per 100,000 population and was higher by 29% than in 2014. Chronic infections and UNK occurred 1.3-fold more frequently in men than in women and 1.5-fold more frequently among urban dwellers than in rural population. In 2015, three people died due to acute hepatitis B, and 57 people due to chronic. CONCLUSIONS: The changes implemented in surveillance in 2014 allow for gradual reducing of territorial disparities and for assessment of the actual number of newly detected infections. Maintenance of a low incidence of acute hepatitis B provides the premise for sustain existing preventive measures, especially universal vaccination of newborns and recommendation to vaccinate of all persons previously unvaccinated.