Analysis of enterobiasis in the Czech Republic in 2018-2022. / Analýza výskytu enterobióz v Ceské republice v letech 2018­2022.

AIM: Pinworm infection (known as enterobiasis or oxyuriasis) is one of the most common parasitic diseases globally and in the Czech Republic (CZ). The aim of this study is to analyse the available epidemiological data on the incidence of enterobiasis in the CZ from 2018-2022. METHODS: A descriptive analysis was done of enterobiasis (ICD-10 code B80) data reported to the electronic Infectious Disease Information System in the CZ from 2018 to 2022. Data processing and analysis were conducted using MS Excel 2016. Univariate and multivariate logistic regression analyses were performed to assess the association between the probability of hospitalization and categorical variables using STATA version 17. The ECDC Map Maker tool (EMMa) was used to create the incidence map. RESULTS: A total of 4,836 cases were reported during the study period, with an average annual incidence of 9.1 cases per 100,000 population. The highest number of cases occurred in 2019 (n = 1,174), and the lowest in 2021 (n = 780). The disease was most common in the paediatric population, with the highest average age-specific incidence rates observed in children aged 5-9 years (80.9 per 100,000 population) and 10-14 years (42.3 per 100,000 population). Of 14 administrative regions of the CZ, the Olomouc Region had the highest average annual incidence (28.7 per 100,000 population), while the Pilsen Region had the lowest (2.2 per 100,000 population). A total of 472 (9.8%) patients needed hospitalization, most of them in the categories 10-14 years (n = 200, 42.4%) and 5-9 years (n = 178, 38%). The highest hospitalization rate was found in the age group 75+ (36.4%). A significantly higher probability of hospitalization was found in the age groups 6-19 years and 65+ compared to working-age population with enterobiasis. A significantly lower probability of hospitalization was seen in 2020-2022 compared to 2019. No difference in the hospitalization rates was noted between genders. No enterobiasis-related death was reported during the study period. The disease occurs year-round. A decrease in reported cases was observed annually during the school summer holidays in July and August. Neither outbreak nor imported cases were noted. CONCLUSION: Given that enterobiasis is often asymptomatic, many cases are not captured in the surveillance system. The Czech prevalence data indicate that it mainly affects the paediatric population. Therefore, preventive measures and programs should primarily target children.

Peculiarities of Q fever and human cases reported so far in the Czech Republic.

INTRODUCTION: Q fever is a zoonosis with a worldwide occurrence. Coxiella burnetii infection is most commonly transmitted by inhalation of air containing contaminated dust in cow, sheep and goat farming areas. The other modes of transmission are alimentary route (ingestion) and through sucking ticks. We set ourselves the goal of presenting a descriptive analysis of cases of Q fever in the Czech Republic (CZ) and former Czechoslovakia and draw attention to this often-overlooked issue. METHODS: Summary of available information about Q fever was processed, and a narrative search of published cases of Q fever in the CZ and former Czechoslovakia, in Czech, Slovak and English, without time restrictions was performed. Furthermore, a descriptive analysis of Q fever cases reported to the Czech infectious diseases reporting system in 1982-2021 was done. After analysis, the available information system data were supplemented with data from a search of published scientific literature and weekly reports on the current epidemiological situation of the public health protection authorities of the CZ. RESULTS: The disease has been reported in former Czechoslovakia and then in CZ since 1952. In 1952-1954, six outbreaks were reported with a total of 150 cases, mostly in connection with work with cattle. In 1980, a large-scale outbreak of Q fever affected 526 employees of the cotton production plant at Staré Mesto near Uherské Hradiste. Otherwise, units to dozens of cases were reported. From 1993 to 2021, 27 cases of the disease were detected in the CZ, of which 22 (81.5%) occurred in men. The age range was 0-60 years (mean 31, median 30 years). Seasonality by reporting month was highest in January and September. CONCLUSION: There has been a decline in human cases of Q fever in the European Union (EU) in recent years, and only few cases of the disease occur in the CZ. Still, due to potential severity of the disease, the current climate change with the consequent increase in the spread of ticks as vectors of Coxiella, and animal movements associated with the global market, it is important to consider Q fever in the differential diagnosis. As part of the prevention, it is necessary to ensure compliance with basic hygiene rules, especially in at-risk occupations, and to consume only pasteurized dairy products. Vaccination of humans is not available in EU countries, although vaccination of livestock is possible.

Overview of basic epidemiological characteristics and descriptive analysis of the incidence of human yersiniosis in the Czech Republic in 2018-2020.

OBJECTIVE: The aim was to provide an overview of the basic epidemiological characteristics of human yersiniosis and to analyze the reported epidemiological data on the incidence of this disease in the Czech Republic (CZ) in 2018-2020. METHODS: A descriptive analysis was performed of cases of yersiniosis captured in the Infectious Disease Information System (ISIN) in the CZ in 2018-2020. MS Excel 2010 was used for data processing and sorting. RESULTS: In the CZ, a total of 1,686 cases of yersiniosis were reported in 2018-2020 (average annual incidence of 5/100,000 population). The highest average age-specific incidence was recorded in the age group 1-4 years (31.3/100,000), followed by 0-year-olds (26.9/100,000). In the study period, 942 cases were male and 744 cases were female, with the respective incidences of 6.0 /100,000 and 4.6/100,000. By administrative region, the highest average annual incidences were recorded in the South Moravian (9.1/100,000) and Moravian-Silesian (7.5/100,000) Regions. Hospital admission was required for 14.3% (n = 241) of reported cases. No death or outbreak was reported during the study period. A total of 31 cases were imported from usual recreational destinations. No seasonality was detected in the CZ; however, more cases always occur in January and in the second half of the year. Over the last three years, a stagnant trend in the incidence of the disease has been observed in the CZ. CONCLUSIONS: In 2018 and 2019, yersiniosis (caused by Y. enterocolitica and rarely Y. pseudotuberculosis) was the fourth most commonly reported zoonosis in humans in the European Union (EU), with a stable trend in 2014-2019. The CZ reports an incidence up to three times higher but a 2.5 lower share of hospitalized patients compared to the EU average, which probably indicates that the CZ has an effective surveillance system in place. The trend in the incidence of the disease has stagnated in the CZ and the EU in recent years. The most common vehicle for transmission of yersiniosis to humans is contaminated food, especially undercooked pork, less often vegetables or water. Contamination of products from home slaughtered animals intended for private consumption is likely and would also explain the increased incidence of the disease, particularly in the winter months.

What risk factors affect hospitalisation for confirmed pertussis cases among infants in the Czech Republic?

BACKGROUND: We estimated what risk factors affect hospitalisation for confirmed pertussis cases among infants (child up to 1 year) in the Czech Republic based on data from the questionnaire-based enhanced surveillance system (ESS) in years 2015, 2017 and 2019. METHODS: Retrospective cohort study was conducted in which we assessed demographic, clinical data, vaccination status and risk/protective factors. Vaccination status was extracted from the electronic nationwide notification system (NNS). We performed descriptive, univariable and multivariable analysis using risk ratio (RR) and logistic regression with odds ratio (OR). RESULTS: A total of 104 confirmed cases (27, 13, 64) were reported in the ESS during 2015, 2017 and 2019. Most cases were in age group 1 month (24), more males (57). Fifteen cases were vaccinated and 89 unvaccinated. Of 88 hospitalised cases, 31 cases reported stay in Intensive Care Unit (ICU). The median length of hospitalisation was 8 days. Although the variable vaccinated in infants was statistically significant in a univariable analysis for outcome hospitalisation, RR 0.76 (95% CI 0.53-1.10), it was not in multivariable. Hospitalisation was strongly associated with the younger age group of 0-3 months adjusted by a smoking family member in a household (OR = 9.72; 95% CI: 2.97-31.81). Stay in ICU was strongly correlated with the younger age group of 0-3 months (OR = 5.07; 95% CI: 1.44-17.87) and with a contact with confirmed or probable pertussis (OR = 7.05; 95% CI: 1.36-36.52). CONCLUSIONS: Our study demonstrated younger age and contact with other pertussis case as risk factors for hospitalisation of infants with pertussis. It is necessary to consider adolescent and adult boosters, including vaccination during pregnancy. We suggest integrating the variables from the enhanced surveillance system into the nationwide notification system, in order to simplify the data reporting and evaluation. Further studies are needed to evaluate the ESS and to monitor the vaccination of pregnant women against pertussis.

First evaluation of completeness and sensitivity of the measles surveillance system in the Czech Republic, January 1, 2018 until June 30, 2019.

AIM: The aim of study was to evaluate completeness and estimate sensitivity of the measles surveillance using the new electronic version of the national notification system of infectious diseases (ISIN) in order to assess its performance. MATERIAL AND METHODS: The completeness of measles reporting in the ISIN for demographic characteristics (week and region of reporting, age and gender), date of onset, complications, hospitalisations, vaccination status, used laboratory methods and country of import from January 2018 to June 2019 was assessed. The register from National Reference Laboratory (NRL) and the ISIN were compared using the capture-recapture method (CRM). Cases were matched using unique personal identifier. The total number of measles cases in the population was assessed using the Chapmans formula. Sensitivity of reporting was calculated by dividing the number of reported cases by the CRM estimated true number of cases. RESULTS: In the ISIN, 765 measles cases were registered within specified time period. For many variables 100% completeness was found. The data were missing mainly for vaccination status (20%), serology results (55%) and used laboratory methods (8%). The NRL confirmed 653 patient samples in respected period. Within both registries (ISIN and NRL) the total 612 cases were matched. Estimated real number of measles cases using the CRM was 816 (95% CI: 809-823) compared to 806 reported cases. The estimated surveillance system sensitivity was 98.8%. Five percent (n = 41) of cases tested positively in the NRL were not reported to the ISIN. CONCLUSIONS: We found high level of reported measles data completeness in the ISIN for most variables. Estimated real and reported number of cases was in a good correlation and calculated sensitivity of the ISIN was on very high level. Though, the data sources used in the study were not independent on each other, therefore results may not be fully accurate. The technical changes (more mandatory fields and more logical syntax to check data) in the ISIN to improve data completeness are being recommended. Data providers should report all measles cases to the ISIN with maximum precision in entering individual variables and investigating laboratories should send samples for confirmation to the NRL in required cases.

Non-O1/non-O139 vibrios - occurrence not only in Europe in recent years.

Non-O1/non-O139 vibrios refer to all vibrios except toxin producing Vibrio cholerae serogroups O1 and O139. The prevalence of illness caused by non-O1/non-O139 vibrios steadily increases all over the world in the last 20 years, which is very probably related to global warming. These infections are reported year-round from tropical and subtropical climate zones, but they were also detected in the mild climate zone of the United States of America and Europe. In mild climate, they have markedly seasonal occurrence, typically peaking in May to October. A human can be infected after ingestion of contaminated food, especially seafood and fish, or water or while bathing. In Europe, non-O1/non-O139 vibrios were detected in the Baltic Sea, North Sea and Mediterranean Sea but also in ponds and rivers. Depending on the pathogen entry route, the clinical manifestation may appear as gastroenteritis, otitis, wound infection or severe up to fatal illness, predominantly in immunocompromised patients. There is no specific prevention. Non-specific prevention includes good personal and food handling hygiene practices and avoiding contact of unhealed wounds with sea or surface swimming water. Given the severity and increasing frequency of infections caused by non-O1/non-O139 vibrios, they should be considered in differential diagnosis of gastrointestinal and wound infections, especially in patients with a history of consumption of fish and seafood or with a history of contact of unhealed wounds with sea or other open swimming water.

Listeriosis - an analysis of human cases in the Czech Republic in 2008-2018.

AIM: The aim of our work was to summarize the most important knowledge about listeriosis in humans and to analyse available epidemiological data on this disease in the Czech Republic in 2008-2018. METHODS: We conducted a literature search and descriptive epidemiological analysis of all human Listeria cases reported to the national surveillance system of infectious diseases (EpiDat until 2017, ISIN for 2018) in the Czech Republic in 2008-2018. For data management and analysis, MS Excel 2010 was used. The incidence maps were created using the ECDC Map Maker tool (EMMa). RESULTS: In total, 380 cases of human listeriosis (mean annual incidence of 0.33/100 000 inhabitants) were reported in the Czech Republic in 2008-2018. The highest age specific incidence was detected in 0-year-olds (1.85/100 000) and then in persons over 60 years (mean incidence of 0.95/100 000). Altogether 222 cases were detected in men (mean incidence of 0.39/100 000) and 158 in women (mean incidence of 0.27/100 000). Geographically, the highest mean annual incidence was reported in the Moravian-Silesian Region (0.6/100 000) and Pilsen Region (0.57/100 000). As many as 96.3% of the reported cases required hospital admission. Of 81 deaths related to listeriosis, 50 were directly caused by listeriosis. The highest monthly incidence was observed in June through October and then in January.  The incidence of listeriosis in the CZ shows an oscillating trend over the last 11 years. Neither epidemics nor imported cases were reported to the national surveillance system during the study period. CONCLUSIONS: Listeriosis cases have been on the rise in the European Union (EU) over the last years, while in the CZ, an oscillating and slightly increasing trend has been observed. Generally, cases are reported mostly in the population aged over 64 years (and especially after the age of 84). As there is no vaccine available yet against this disease, the only option is the prevention, i.e., health education of consumers in general and of the risk groups in particular, and compliance with food safety and hygiene standards in food production and handling.

Questionnaire-based epidemiological analysis of acute gastroenteritis outbreak among employees of two neighbouring institutions sharing canteen in Prague 2019.

OBJECTIVES: On 17th Dec 2019 gastroenteritis outbreak occurred in two Pragues neighbouring institutions. Investigation aimed to describe outbreak, identify etiological agent, vehicle and propose control measures. METHODS: Routine outbreak investigation and retrospective cohort study was done. Data collected via online questionnaire were analysed using descriptive, univariate and stratified analysis. RESULTS: Of 960 employees, 276 responded (29%). We identified 39 (14%) cases, one tested norovirus positive. Canteen staff didnt report illness. No food item or environmental sample was tested. Sichuan pork served for lunch on 17th Dec was the most likely vehicle of outbreak (odds ratio (OR) 5.02, 95% confidence interval (CI) 1.98-12.64). Eating Sichuan pork and Chinese soup showed OR 31.5, 95% CI 5.0-320.7. Twenty-two (56%) cases can be explained by consumption of these food items. CONCLUSIONS: Epidemiological analytical method provided evidence of likely vehicle. We did not find the source. Control measures were early ensured and outbreak ceased. We emphasise full outbreak investigation using analytical epidemiology, environmental screening and microbiological testing of cases and possibly all kitchen staff.

Incidence and analysis of campylobacteriosis cases in the Czech Republic in 1997-2017.

AIM: The aim of our study was to conduct analysis of reported epidemiological data on human campylobacteriosis in the Czech Republic (CZ) from 1997 to 2017 and to summarize the current knowledge about the disease. METHODS: We conducted a descriptive epidemiological analysis of data on campylobacteriosis cases reported to the national surveillance system of infectious diseases in the CZ (EpiDat) from 1997 to 2017. MS Excel 2010 and statistical program R were used for data management and analysis. The incidence maps were created using the ECDC Map Maker tool (EMMa). RESULTS: Overall, 411 699 campylobacteriosis cases (average annual incidence of 188.9/ 100 000) were reported in the CZ from 1997 to 2017. Between 1997 and 2005, the annual incidence of campylobacteriosis was increasing sharply, but it showed a fairly stable trend over the last decade. The highest average age-specific incidence of 1 068.5/100 000 was observed in the age group 1-4 years followed by 99% of cases). The most common etiologic agent of campylobacteriosis is Campylobacter jejuni. CONCLUSIONS: Since 2007, campylobacteriosis is the most common food- and water-borne disease in the CZ. Given the high number of cases, this infectious disease is a rising public health concern. The prevention should be focused on the main risk groups, i.e. children under 5 years of age, who are the most affected, and those older than 80 years, who have more complications and a higher hospitalization rate.

Typhoid fever in the Czech Republic and an imported case after return from the Rainbow Gathering in Italy.

Typhoid fever is a disease caused by the highly virulent bacterium Salmonella Typhi. It is transmitted by the oral-faecal route. In the Czech Republic, 53 cases of typhoid fever were reported in 1997-2017. Only seven of these cases were autochthonous. In August 2017, an imported case of typhoid fever was recorded in a 25-year-old unvaccinated woman who participated in the Rainbow Gathering in Italy one week prior to the onset of the disease. During her stay in Italy, she slept in a tent, ate her own food, and drank unboiled water. Presenting with persisting cough, tiredness, muscle and joint pain, and fever up to 40 °C after her return, she was admitted to the Třebíč Hospital where she was diagnosed with S. Typhi. The epidemiological investigation identified six contacts. On discharge from hospital and at follow-up, the patient was tested negative. None of the contacts became ill.

Recurrent outbreaks caused by the same Salmonella enterica serovar Infantis clone in a German rehabilitation oncology clinic from 2002 to 2009.

BACKGROUND: Repeated outbreaks of salmonellosis caused by Salmonella enterica serovar Infantis at a rehabilitation clinic in Germany were investigated microbiologically from August 2002 to August 2009. AIM: To identify the sources of transmission and characterize the S. enterica serovar Infantis isolates. METHODS: Associated with these outbreaks, isolates from 98 patients, two kitchen staff, five food samples, four swabs of kitchen facilities, three samples of chicken faeces and one sample of sewage water were evaluated by phage typing. All S. enterica serovar Infantis isolates investigated (N=113) were related to phage type (PT) 29. Additionally, 44 of the 113 isolates were selected at random for typing by XbaI macrorestriction and pulsed-field gel electrophoresis (PFGE). FINDINGS: Typing of the 44 isolates showed that the recurrent infections were caused by the single clone PT 29/XB27+44 (42/44, 95.5%). The most likely route of transmission was only identified in the last outbreak in 2009 within the present study. It was found to be cross-contamination in the kitchen facilities (emanating from a contaminated wooden panel), in combination with carriers among the kitchen staff. CONCLUSIONS: This study demonstrated important details of hospital-specific epidemiological processes, and alludes to a long-term reservoir of an epidemic clone of S. enterica serovar Infantis either in a backyard flock of poultry or in an inanimate kitchen reservoir.

Comparative varicella vaccine effectiveness during outbreaks in day-care centres.

BACKGROUND: Routine varicella vaccination for children >11 months was introduced in Germany in 2004 with three different vaccine brands available. In 2008 and 2009, we investigated seven varicella outbreaks in day-care centres (DCC). METHODS: Varicella disease and vaccination status of 1084 children was reviewed to evaluate vaccination coverage (VC), brand-specific varicella vaccine effectiveness (VE), and risk factors of breakthrough varicella (BV, >42 days after vaccination). A case was defined as a child with acute onset of varicella attending one of the respective DCC at the time of outbreak. Children with a previous history of varicella, age<11 months, vaccinated at age<11 months or <42 days before disease onset or during the outbreak were excluded from VE and BV risk factors analyses (adjusted for gender, age and DCC). FINDINGS: Of 631 children with available vaccination information, 392 (62%) were vaccinated at least once. Overall VE among 352 children eligible was 71% (95% confidence interval (CI) 57-81, p<0.001) and differed significantly by disease severity and number of doses administered. Risk for BV was higher for 1 dose of Varilrix (RR=2.8, 95%CI 1.0-7.8, p=0.05) or Priorix-Tetra (RR=2.4, 95%CI 0.7-8.3, p=0.18) but lower for 2 doses of Priorix-Tetra (RR=0.5, 95%CI 0.1-2.7, p=0.41) than for 1 dose of Varivax. INTERPRETATION: Enhanced efforts to increase VC in Germany and 2 doses varicella vaccine might be successful to reduce the risk for BV. The evidence that VE and risk of BV are associated with vaccine brand needs further investigation.