Carriage of Neisseria meningitidis in newly enlisted young military professionals during the COVID-19 pandemic

Aim: Invasive meningococcal disease (IMD) is still a major threat not only to the youngest age group of children but also to adolescents and young adults. Higher rates of meningococcal disease have also been reported in specific at-risk groups, such as secondary and tertiary students and members of the military. Infection occurs after close contact with a clinically ill individual, but most often with an asymptomatic carrier. The aim of our study was to determine the prevalence of carriage of N. meningitidis in young persons newly enlisted in the Army of the Czech Republic (ACR). Material and methods: During August 2021, persons entering the service in the ACR were asked to participate in the presented study approved by the Ethics Committee. Nasopharyngeal and oropharyngeal swabs were collected from the study participants in August. A questionnaire survey was administered to each of them after signing an informed consent form. The biological samples were cultured on the day of collection and analysed for N. meningitidis. In case of meningococcal detection, the serogroup of N. meningitidis was determined. For most of the study participants, swabs were repeated after 2-3 months, in October and November. Swabs were also collected from additional participants, namely students entering the first year of bachelor and master studies at a military college. Results: A total of 252 newly recruited young military professionals, 201 males and 51 females, were included in the study. Carriage of N. meningitidis was found in 13 study participants, i.e., 5.2 % of all tested subjects, with a predominance of positive findings in the summer period. All carriers were males while in females, meningococcal carriage was not detected. In carriers, serogroup B was predominant over non-groupable isolates (NG). There was no evidence of carriage of meningococcal groups A, C, W, X, or Y. Meningococcal isolation was significantly more successful from oropharyngeal compared to nasopharyngeal swabs. Only in five of 17 positive findings, meningococci were detected from both the oropharynx and nasopharynx. No isolation was made from the nasopharynx alone. Conclusion: The lower percentage of meningococcal carriage in young military professionals in the Czech Republic in the study period 2021 as compared to similar reports on military collectives from other countries can be attributed to the current epidemic situation, where the measures taken in connection with the efforts to prevent the spread of COVID-19 resulted in the loss of seasonality of respiratory diseases and also their significantly lower incidence. This correlates with a reduction in carriage in the monitored age category.

Epidemiology of vancomycin-resistant enterococci in the Hradec Králové University Hospital in 2017.

Vancomycin-resistant enterococci (VRE) have been a major public health concern for years. These pathogens are highly resistant, which facilitates their spread in health care settings where they may cause infections difficult to treat with antibiotics, particularly in immunocompromised patients. Over recent years, a considerable increase in VRE has also been observed in the Hradec Králové University Hospital. In 2017, 59 cases of VRE colonization or infection were newly diagnosed in inpatients. Based on a retrospective investigation, infected patients were identified, and from the hospital information system data, clinical and epidemiological factors possibly linked to VRE were analysed. It was concluded that one of the reasons behind the increase in VRE was poor compliance with the hygienic antiepidemic rules in general and with hand hygiene in particular, which was confirmed by the changed epidemiological situation the following year after more stringent rules were adopted. Raising awareness of health care workers about good practices to reduce the risk of the spread of resistant pathogens is crucial for the prevention of these infections.

In-vivo interspecies transmission of carbapenemase KPC in a long-term treated female patient.

The increasing incidence of multiresistant bacterial strains is currently a serious health concern. These pathogens are often the cause of nosocomial infections with limited treatment options and high fatality rates. A case report is presented of an uncommon detection of four different species (Citrobacter freundii, Klebsiella pneumoniae, Escherichia coli, and Morganella morganii) producing the same type of carbapenemase, KPC-2, in a female patient during her complicated long-term hospital stay. Resistance was probably spread to other species by horizontal transmission of plasmids carrying the blaKPC-2 genes. The implementation of strict anti-epidemic measures prevented further spread of these carbapenem-resistant bacteria.

Prevalence of hepatitis C virus infection in adults with the risk factors.

In 2017 chronic hepatitis C (CHC) seems to be a curable disease in most cases. Analysis of epidemiologic data of hepatitis C virus (HCV) infection gained from a primary care office shows how HCV is underdiagnosed in the Czech Republic (CZ). The importance of primary care in screening of HCV infection is shown, as is the necessity of spreading information about this disease between common population and healthcare workers. The aim of the study is to determine seroprevalence of HCV antibodies and HCV ribonucleic acid (RNA) positivity among registered patients with risk factors (RF) in medical history in one physician´s practice. 1620 complete follow-ups of registered clients were accomplished during a 10-month period between 2016 and 2017 in the office of one general practitioner (GP). Amongst those 627 were confirmed to have RF. Each client with RF was tested for HCV antibodies, including detection of HCV RNA via polymerase chain reaction (PCR) method in cases of HCV antibodies positivity. 19 anti HCV positive clients were found, with a prevalence of 3.03%, 5 were HCV RNA positive, with a prevalence of 0.8%.

Seroepidemiology of whooping cough in the Czech Republic: estimates of incidence of infection in adults.

OBJECTIVES: Despite widespread vaccination programmes, pertussis remains a significant health burden in many countries. Low awareness of the disease, the high rate of asymptomatic cases in adults and difficulties with diagnosis could explain the under-reporting of pertussis. The lack of data on actual incidence constitutes an obstacle for public health authorities for the implementation of a vaccination strategy against pertussis in adults. The aim of this study was to evaluate the seroprevalence of antibodies against Bordetella pertussis infection in adults and to estimate the actual incidence of the disease compared with the reported incidence. STUDY DESIGN: Prospective, multicentre seroprevalence study. METHODS: The study was conducted in 2000 adult subjects aged ≥18 years who had not received pertussis vaccination within the last 5 years. All enrolled subjects provided a blood sample for serum testing of IgG antibodies against pertussis toxin, performed by enzyme-linked immunosorbent assay, to indicate if they had an acute infection or if they had been infected with pertussis within the last 12 months or earlier. Results were validated in accordance with the guidelines of the European Sero-epidemiology Network 2 and were expressed in ESEN units/ml. RESULTS: A positive concentration of anti-pertussis toxin antibodies, indicating previous pertussis infection, was demonstrated in 39.9% (n = 799) of all study subjects, and 0.40% (n = 8) of subjects had a concentration suggestive of a recent infection (within the last 12 months). The highest antibody seroprevalence was observed in subjects aged 18-29 years (1.46%). No cases of acute infection were detected. CONCLUSIONS: During the study period, the reported incidence of pertussis in the adult population was 0.84/100,000 inhabitants. Based on the seroprevalence results from this study, it is estimated that the actual incidence of pertussis could be as much as 699/100,000 inhabitants. The actual incidence of pertussis in adults in the Czech Republic could therefore be at least 200-fold higher than the reported incidence. These findings support the need for pertussis vaccination in the adult population.

[The incidence of viral hepatitis A in the Hradec Králové Region in the Czech Republic in the last decade]. / Výskyt virové hepatitidy typu A v Královéhradeckém kraji Ceské republiky v posledním desetiletí.

OBJECTIVE: Viral hepatitis A continues to occur in the Czech Republic due to the high susceptibility of the population and existing opportunities for the transmission of the disease. The aim was to describe and analyse the incidence of viral hepatitis A in the Hradec Králové Region in the Czech Republic in 2005-2014, including the study of two outbreaks that required a different approach of field epidemiologists. MATERIAL AND METHODS: In 2015, a retrospective analysis was carried out of the data on the incidence of viral hepatitis A in Hradec Králové Region in 2005-2014. The EPIDAT system where cases of infectious diseases and data from epidemiological investigations are reported was used as a data source for the purposes of the present analysis. In addition, two final reports on epidemic outbreaks of viral hepatitis A from 2014 were assessed. RESULTS: The incidence of viral hepatitis A at the regional level follows, to a certain extent, the pattern of the incidence of this disease at the national level. The highest number of cases was reported in 2010 due to a country-wide epidemic. The most affected age groups were children, adolescents, and young adults. The incidence of viral hepatitis A in individual years has a significant effect on the emergence of local outbreaks. CONCLUSION: The incidence of viral hepatitis A in the Czech Republic has a fluctuating trend, at both the national and regional levels. The highest incidence of viral hepatitis A was observed in the younger and middle-age categories. The high susceptibility of these population groups suggests the importance of vaccination against viral hepatitis A that confers specific personal protection.Key words: viral hepatitis A - incidence - outbreak - Czech Republic.

[Pandemic of hepatitis C virus infection]. / Pandemie infekce virem hepatitidy C.

UNLABELLED: Hepatitis C virus (HCV) is an important human pathogen that causes hepatitis, advanced liver fibrosis, cirrhosis (CIH), and hepatocellular carcinoma (HCC). Especially the chronic form of hepatitis C (HC), with 55-85% of acute cases progressing to it, is a serious problem worldwide. HCV is a cause of the significant morbidity and mortality that are only expected to peak. An ongoing research of new therapeutic molecules for the treatment of HCV infection is a promise for a better future. The costs incurred are, however, high. KEY WORDS: hepatitis C - genotypes - prevalence - risk groups - HCV-associated diseases.

[Novel approaches to control the rise in pertussis cases]. / Nové prístupy v kontrole vzestupu poctu onemocnení pertusí.

UNLABELLED: Pertussis is a respiratory disease caused by the Gram-negative encapsulated bacterium Bordetella pertussis. Despite the high vaccination coverage rate and addition of new booster doses to the immunisation scheme (in response to the epidemiological situation), pertussis is on the rise not only in the Czech Republic but also in many other countries. The age groups at highest risk are infants and, to a lower extent, newborns who can get infected before receiving the first dose of vaccine and develop a severe course of the disease, often requiring admission to hospital. The most common source of infection are adults or adolescents from the childs close environment who experience a mild course of the disease because of the previous vaccination. The immune response induced by the currently available acellular vaccines does not last. It can be reasonably assumed that pertussis has been underreported. Multiple studies have shown mutations in the causative bacterium that confer higher pathogenicity to it, either as a result of enhanced production of pertussis toxin or loss of some antigens. Possible strategies to control these negative trends are to develop novel more effective vaccines using new adjuvants or to use whole-cell vaccines. Maternal vaccination in pregnancy trimester 3 also turned out to be effective. KEY WORDS: pertussis - vaccination - epidemiology - diagnosis - newborns.

[Prevalence study of nosocomial infections in university hospitals in the Czech Republic]. / Prevalencní studie nozokomiálních nákaz ve fakultních nemocnicích v Ceské republice.

OBJECTIVE: In 2005-2010, a nosocomial infection prevalence study was conducted in 12 university hospitals, namely at the departments of surgery, urology, neurology, cardiology, neurosurgery, otorhinolaryngology, and traumatology. The primary objective was to evaluate the overall epidemiological situation of nosocomial infections (NI) at the highest risk departments of selected healthcare facilities in the Czech Republic and to characterize the NI detected. METHODS: To collect data, a questionnaire survey method was used, as it suited the routine operation conditions in healthcare facilities and was inexpensive, easy to understand, reproducible, and repeatable if needed. The questionnaire was designed according to the protocol recommended by the working group HELICS (Hospital in Europe Link for Infection Control through Surveillance). In each of the participating hospitals, the medical records of all patients hospitalized at the respective departments were analyzed. The patient data, hospitalization data, potential risk factors, and occurrence of hospital infection, if any, were derived from the medical records and entered in the questionnaire. RESULTS: Overall, data on 1889 hospitalized patients were analyzed. Eighty-one confirmed NI cases were found, i.e. the prevalence rate in this study was 4.3% (the percentage of HI per the number of hospitalized patients), which is in agreement with the recent data reported in the European Union. The most common causative agents were Pseudomonas spp. (16%), Staphylococcus aureus (15%), Escherichia coli (12%), Proteus spp. (10%), and Klebsiella spp. (4%), with the urinary tract (41%) and respiratory tract (23%) being affected most often.

[Current situation in clinical trials with vaccines in the Czech Republic]. / Soucasnost klinických studií ockovacích látek v Ceské republice.

Clinical trials are an important part of clinical research. The conduction of clinical trials is strictly regulated and has to comply with an approved protocol. Local regulatory authorities, independent ethic committees, sponsors of clinical trials as well as the investigators are involved from the submission until the very end of the trial. All clinical trials performed in the Czech Republic have to be approved by the State Institute for Drug Control and by the Ethics Committee. The regulatory bodies and independent ethics committees evaluate and continuously supervise the justification and protocol of the clinical trial, quality of the investigational medicinal products and, primarily, the safety of the participants (patients and/or healthy volunteers) in clinical trials. In the Czech Republic there are many advanced clinical research centres, either located in private practices or within hospitals. The investigators are able to conduct a wide variety of clinical trials and recruit a high number of subjects for the trials, as well as to comply with the Good Clinical Practice guidelines and other regulatory requirements. The aim of this article is to summarise the current situation of clinical trials in the Czech Republic as well as the opportunities for getting involved in clinical trials and obligations arising for health professionals from such an involvement.

[Opposite trends in the incidence of gonorrhea and syphilis in the East Bohemian Region - 30 years of surveillance]. / Protikladný vývoj trendu incidence kapavky a syfilis ve východoceském regionu - 30 let surveillance.

The epidemiology of selected sexually transmitted diseases in the Czech Republic has been carefully evaluated for many years. Data from 1981-2011 for eastern Bohemia shows a sharp decrease in the incidence of gonorrhea in 1993-1994 and a very low incidence thereafter with a slightly higher prevalence in males. However, syphilis and genitourinary infections with Chlamydia trachomatis show entirely opposite trends. Also, for the similar number of diagnostic tests performed, Chlamydia had a 10 fold higher rate of positive results. This underscores the changing epidemiology of sexually transmitted infections (STI) and necessity for adapting the reporting algorithms accordingly.

[An increase in the prevalence of syphilis in women in Eastern Bohemia - 30 years of surveillance]. / Rust prevalence syfilis u zen ve východoceském regionu - 30 let sledování

Epidemiological data on sexually transmitted infections in the Czech Republic has been carefully reported for many years. Here we present an analysis of regional data on syphilis spanning more than 30 years in eastern Bohemia. The epidemiological data were derived from the mandatory reporting of sexually transmitted diseases covering the period 1981-2011. The data showed a minimal incidence of cases in 1990 and an increasing trend thereafter. Two peaks in the incidence are apparent - within years 1995-1999 and 2003-2007. Interestingly, while before 1990 the numbers of positive men always exceeded those of women, their numbers equalized or even reversed within the two peaks. The results may also reflect trends in social change in the country after 1989. The analysis showed that the regional prevalence of syphilis in eastern Bohemia still remains low compared to some other regions of the Czech Republic.

[Vaccination against viral hepatitis A and B in adults aged over 40 years--antibody persistence and immune memory]. / Ockování proti virové hepatitide A a B u dospelých starsích 40 let veku--sledování pretrvávání protilátek a imunitní pameti.

STUDY OBJECTIVE: Primary vaccination with combined vaccine against viral hepatitis A (VHA) and viral hepatitis B (VHB) induces higher anti-hepatitis B surface (anti-HBs) antibody responses and similar anti-hepatitis A virus (anti-HAV) antibody responses in adults aged over 40 years in comparison with concomitant monovalent vaccines against VHA and VHB. Th e objectives were to assess, in a clinical study, persistence of anti-HAV and anti-HBs antibodies in adults aged over 40 years four years after primary VHA/VHB vaccination and antibody response following a booster dose of the vaccine. MATERIAL AND METHODS: Five hundred and ninety-six subjects aged > 40 years were vaccinated with three doses of the combined VHA/VHB vaccine at Months 0, 1, 6 (HAB group) or with concomitant VHA and VHB vaccines at Months 0, 6 and 0, 1, 6 (ENG+HAV and HBVX+VAQ, respectively). Blood samples were collected one month following primary vaccination (Month 7) and then at one-year intervals for four years after the booster dose with the same vaccine as used for the primary vaccination. The anti-HBs and anti-HAV antibody levels were determined prior to the booster dose and at days 14 and 30 after the booster dose. RESULTS: At Month 7, > 97% of study subjects were seropositive for anti-HAV antibodies in all groups analyzed. Four years after primary vaccination, anti-HAV antibody seropositivity persisted in > 93% of study subjects, increasing to > 99% after the booster dose. At Month 7, the highest proportion of study subjects with anti-HBs antibody levels > or = 10 mIU/ml was found in the HAB group (91.7% versus 79.7% in the ENG+HAV group versus 71.0% in the HBVX+VAQ group). Four years after vaccination, anti-HBs antibody levels of 10 mIU/ml persisted in 57.1% of the HAB study subjects in comparison with 40.1% and 26.6% of the study subjects in the ENG+HAV and HBVX+VAQ groups, respectively. One month after the booster dose, anti-HBs antibody levels increased and antibody levels > or = 10 mIU/ml was achived in 95.2% of study subjects in the HAB group, 90.5% in the ENG+HAV group and 85.3% in the HBVX+VAQ group. CONCLUSION: In the adults aged over 40 years, an adequate anti-HAV antibody response persisted for at least four years after vaccination and was higher and more sustained in those who received the combined HAB vaccine. A strong antibody response to the booster dose indicative ofthe presence of immune memory was seen in all study groups.

Paediatric pneumococcal disease in Central Europe.

Streptococcus pneumoniae causes considerable global paediatric morbidity and mortality, despite the availability of safe and effective pneumococcal conjugate vaccines (PCVs). To justify the introduction of PCVs, accurate information on the burden of disease is required. Here, we present an appraisal of the pneumococcal epidemiological situation in 11 Central European countries. The data are based on study findings presented at the 12th Central European Vaccine Advisory Group (CEVAG) meeting, held on 21-22 May 2010 in Sofia, Bulgaria, and a literature review of the PubMed database using the search terms 'pneumococcal' or 'Streptococcus pneumoniae', in combination with 'otitis media', 'pneumonia', 'meningitis' or 'bacteraemia/sepsis', and '[Central European country name]'. The incidence of pneumococcal disease appears to be lower in Central Europe than previously reported for Europe as a whole, with the highest risk in infants aged 0-2 years. The fatality rates in the under fives from invasive infections are up to 40%. A paucity of comprehensive country-specific data on pneumococcal disease burden arises from the lack of homogenous surveillance programmes. Standardised, active surveillance systems are required for the accurate evaluation of the pneumococcal disease burden in the region. Only then can the need for vaccination be addressed.

[Polio news]. / Novinky na poli poliomyelitidy--krátké sdelení.

Although the Word Health Organization (WHO) launched the global polio eradication initiative 22 years ago, reports of new cases of this serious disease from various parts of the world are far from being uncommon. Former Czechoslovakia became the first country in the world to achieve polio eradication at the nationwide level. Since summer 1960, no case of non-imported paralytic poliomyelitis has been reported since 1961, Czechoslovakia has been the first country in the world to control permanently the spread of wild poliovirus strains.

Molecular epidemiology of varicella zoster virus.

Varicella zoster virus has highly conserved genome 125,000 base pairs. The different molecular genetic methods of analyzing VZV genome are discussed, as well as their results with regards to the virus phylogenesis, geographic distributions, possible recombination and virulence of different VZV strains.

[Herpes zoster in the Czech Republic--epidemiology and clinical manifestations]. / Herpes zoster v Ceské republice--epidemiologie a klinické projevy.

Herpes zoster (shingles) is a viral infection of the skin that manifests itself as painful, unilateral vesicular rash. The causative agent is varicella-zoster virus (VZV). Primary infection with VZV causes chickenpox, a common childhood infection, and then the virus lies dormant in the sensory neural ganglia, reactivating to cause shingles. The most important complications are neurological disorders (in particular postherpetic neuralgia) and eye disorders. First-line therapy are antiviral agents. A single vaccine has been registered to date. Herpes zoster occurs sporadically in the Czech Republic and its incidence is long-term stable. In 1990-2008 the average annual incidence was 6306 cases (61.3 cases/100,000 population), with the lowest number of 5511 cases (53.5/100,000) reported in 1991 and the highest number of 6,894 cases (67.6/100,000) reported in 2002. The incidence rate in females (69.9/100,000) was 1.4 times as high as in males (49.5/100,000). From the age perspective, the elderly are at a considerably higher risk of developing shingles. In 2008, the incidence rate was the highest in the age group 70 years (155.0/100,000). Nevertheless, the beginning of the upward trend is seen in the age group 45-49 years. Herpes zoster does not show any seasonal trend.

[New options of influenza vaccination]. / Nové moznosti ockování proti chripce.

One of the ways to increase a low rate of vaccination against the flu in the Czech population is using new vaccination methods, e.g. the intradermal flu vaccine application method. This method uses a high skin immune potential, where a great amount of dendritic cells, macrophages, lymphocytes as well as abundant capillary and lymphatic supply can be found. A progressive microneedle application system allows the accurate application right into the dermis and a dosage consistency without any necessity of much experience and training in intradermal administration. Comparable results of immunogenity with lower antigen content and less vaccine amount are reached with intramuscular application in adults up to 59. Using the same antigen amount as in intramuscular application in people older than 60, significantly better results are reached. A new intradermal vaccine IDflu is registered in Europe for people from the age of 18 and it is considered to be a new alternative way to raise popularity of flu vaccination in lay and professional public. The microneedle intradermal application system brings an easier way of vaccination for doctors with application of less amount of vaccine and there is no need to remove air from the syringe and no need of aspiration. The vaccine will be introduced in the Czech market before the flu season 2010/2011.

[Prion diseases]. / Prionové nemoci.

The group of prion diseases includes many diagnoses which have been long known. Nevertheless, the general awareness of these diseases increased substantially with the outbreaks of bovine spongiform encephalopathy (BSE) and the emergence of a new variant of Creutzfeldt-Jakob disease (nvCJD) at the close of the XXth century. Although major advances have been made in this field, further research is required to better understand these diseases. Many questions related e.g. to the accurate definition of the causative agent, pathogenesis, diagnosis and treatment still need to be addressed. The aim of this article is to present the latest knowledge of the etiology and epidemiology of these diseases with a focus on BSE and nvCJD, including measures taken for their control.

[Immunogenicity of vaccines against viral hepatitis A and B in the population above 40 years of age -- impact of risk factors]. / Imunogenita vakcín proti virovým hepatitidám A a B u osob starsích 40 let -- vliv rizikových faktoru.

UNLABELLED: The immune reaction following vaccination against viral hepatitis A (HAV) and viral hepatitis B (HBV) can be influenced by a variety of factors. Among the most important are age, gender and body weight. STUDY OBJECTIVE: This prospective randomized study compared immunogenicity of available vaccines against HAV and HBV infections in the population above 40 years of age and the impact of risk factors. MATERIAL AND METHODS: The vaccinated subjects were divided into 3 groups based on the vaccine used. Within each group, the subjects were equally distributed by age, gender and body weight. The vaccine was always applied intramuscularly in the deltoid. Group 1 was given the combined vaccine Twinrix (GSK) against HAV and HBV infections in the left deltoid; group 2 was vaccinated with the Havrix vaccine against HAV (GSK) in the right deltoid and with the Engerix-B vaccine against HBV (GSK) in the left deltoid; group 3 received the Vaqta vaccine against HAV (Sanofi Pasteur) in the right deltoid and the HB VAX PRO against HBV (Sanofi-Pasteur) in the left deltoid. RESULTS: The following anti-HBs seroprotectivity rates: 92%, 80% and 71%, and anti-HAV seropositivity rates: 97%, 99% and 99%, were observed at 1 month after the end of the complete vaccination in groups 1, 2 and 3, respectively. The anti-HBs seroprotectivity rate was statistically significantly higher in group 1. The anti-HAV seropositivity rates were comparable (did not significantly differ) in all three study groups. CONCLUSION: The impact of age was revealed: the immune response decreases with increasing age. The lowest immunogenicity of the vaccines against HAV and HBV infections was observed in subjects above 60 years of age. Males achieved lower geometric mean titres (GMT) of antibodies and lower seroprotectivity rates compared to females. The impact of body weight was also observed, with the obese subjects showing the lowest immune response. The anti-HBs reactivity was significantly influenced by the vaccine used. The combined vaccine against HAV and HBV infections (Twinrix) induced higher anti-HBs seroprotectivity and comparable anti-HAV seropositivity when compared with the other monovalent study vaccines in the population above 40 years of age.