Results of Vaccination Coverage in the Czech Republic

Introduction: Data on vaccination against preventable vaccine diseases are among the basic epidemiological indicators necessary to evaluate the success of vaccination campaigns and the effectiveness of the vaccination schedule in the prevention of infectious diseases. Without the existence of a national vaccination registry, this requirement cannot be successfully met. At present, we can monitor vaccination coverage in adults only in the national register of paid health services, based on reports from health insurance companies about vaccinations paid for by health insurance, which is still the minimum for adults. From 2022 onwards, we can expect vaccination data against tick-borne encephalitis in people over 50 and against the flu in healthcare professionals. Another way of determining adult vaccination coverage is based on vaccine sales, i.e. data from vaccine manufacturers that are inaccurate. The last option is to determine the vaccination coverage of adults on the basis of questionnaire surveys. But we still lack accurate robust data. At the same time, the World Health Organization has recommended to set up registers of vaccinated people long ago. Adult vaccination coverage: Insufficient interest in some vaccines, and consequently small volume of influenza vaccine imports, makes it impossible to increase vaccination coverage in the 2021/2022 season beyond vaccine imports. Given the planned import of 1,080,000 doses of influenza vaccine in 2021 for 10.7 million people, we can reach a maximum of 10.1% vaccination coverage this season. In 2020, there was a decrease in the vaccination coverage of people aged 65+ against pneumococcal diseases. The cause may be remote health care for the elderly, limited preventive care and fear of doctor visits during the COVID-19 pandemic. In 2020, 24.8% influenza vaccination coverage was achieved in institutionalized persons (persons in homes for the elderly, in long-term care facilities, in homes for the disabled, in homes with a special regime);24.5% influenza vaccination coverage in people aged 65 and over. Low influenza vaccination coverage was also achieved in 2020 in chronically ill patients (23.8% in patients with chronic obstructive pulmonary disease, 23% with kidney disease, 20.8% with diabetes mellitus, 17.0% with cardiovascular disease and 11.2% with bronchial asthma). Compared to the data for the period 2010–2020, there was a decrease in vaccination coverage of institutionalized persons (a decrease of 8 percentage points). A lower number of vaccine doses compared to the previous year was also administered against tetanus in 2020 (a decrease of 21%). On the contrary, in 2020 there was a slight increase in vaccination against tick-borne encephalitis, from 29 to 33%. Unfortunately, almost half of those vaccinated did not complete the basic vaccination schedule. Conclusion: Despite significant improvements, we still do not have sufficient data on adult vaccination coverage. The creation of a national register of vaccinees and an electronic vaccination card is a necessity. COVID-19 has contributed to the decline in vaccination coverage of seniors and institutionalized individuals. Unlike children, we achieve significantly lower adult vaccinations in comparasion with international recommendations and with developed countries. © 2021, EEZY Publishing, s.r.o.. All rights reserved.

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.

Child vaccination coverage of selected infectious disease in the Czech Republic

Introduction: Vaccination control is performed by all European Union countries, but uniform standards for the collection of valid data are still lacking. The analysis of vaccination data is used to evaluate vaccination programs and their effectiveness in preventing the occurrence of infectious diseases at the national level. Vaccination information also helps to plan the required amount of vaccines in advance so that outages do not occur and deliveries are smooth. Various methods are used for the purpose of determining vaccination coverage, namely administrative methods, surveys, including seroprevalence or direct use of data from immunization programs. Methods based on the use of data from vaccination registers are another way of obtaining information about vaccinations. Thanks to the change in the payment of compulsory vaccination and the introduction of paid vaccination from health insurance, we have now had the opportunity in the Czech Republic to monitor and analyze data from health insurance companies on the vaccination of the population in selected preventable diseases. The data are managed by the Institute of Health Information and Statistics of the Czech Republic within the National Health Information System and national health registers. Data from health insurance companies on the number of reported vaccination doses, including used vaccines, are available in the National Register of Paid Health Services. The register contains data from health insurance companies in the inpatient and outpatient areas, including complete data on reported diagnoses, procedures and treatment. The national information system of the public administration enables the determination of the number of administered doses of the vaccine on the basis of the used registers, also in relation to the number of inhabitants of the given year of birth and their permanent residence. Vaccination in children: Full-term infants born from 1 January 2018 are vaccinated with a combined vaccine against diphtheria, tetanus, pertussis, viral hepatitis B, poliomyelitis and invasive infections caused by Haemophilus influenzae type b (hexavaccine) in scheme 2 + 1, unlike the original 3 + 1 dose, which remains valid for premature babies born before the 37th gestational week of pregnancy. The National Register of Paid Health Services data were used to monitor vaccination coverage. Vaccination in the case of hexavaccine in infants born in 2018 reached 94.8%, in children born in 2019 then 95.2% with the monitored parameter of administration of at least one dose of vaccine up to one year of age. A similar change of the scheme to 2 + 1 occurred in the case of optional vaccination against pneumococcal infections in infants, where we observe an increase in vaccination coverage from 66.9% in chlidren born in 2017 to 73% in children born in 2019 when monitoring the administration of at least one dose up to one year of age. In the case of the combined measles, mumps and rubella (MMR) vaccine, above 90% (90.3%) of two-year-olds born in 2018 receive a first dose vaccination. The revaccination against tetanus, diphtheria and pertussis (Tdap) in five-year-olds in 2019 reached 90%, in the previous year 2018 it was 91.2%. In the case of revaccination of children aged 10-11 years with the combined vaccine together with revaccination against poliomyelitis (Tdap-IPV), based on the data for 2020, the vaccination coverage reached 91.7%, while in the previous year of children it was 94.5%. In the case of vaccination against human papillomavirus (HPV) diseases, there is a slight increase in the number of vaccinated girls and boys, with a current vaccination prediction of 63.6% for girls in 2020 and 42.6% for boys. In addition, in 2020, thanks to the amendment to Act No. 48/1997 Coll. on public health insurance, we managed to launch optional paid vaccinations for infants and toddlers against meningococcal infections and thus extend the national immunization program to include additional vaccinations. Despite this spread, there has been no decrease in vaccination coverage in infa ts and toddlers with other vaccines. Conclusion(s): Despite the ongoing epidemic of covid-19, preventive child care was maintained in the Czech Republic in 2020 and there was no decrease in vaccination coverage for compulsory and optional (paid) vaccinations for infants and toddlers. On the contrary, we managed to implement additional optional vaccinations paid for from public health insurance funds, also thanks to the acceleration of the legislative process within the declared state of emergency. The epidemic shows the importance of adherence to preventive measures and the need for early prevention of the disease using vaccination programs. Unfortunately, the burden of the epidemics has been delayed by the possibility of repeated publication of updated data on vaccination coverage of children from the national registers of paid health care and are thus published at a delay. The lack of data obtained in this way still remains, the method is limited only for paid vaccinations from public health insurance funds, ie without records of vaccinations paid for by the parents of children. In the future, we will not do without registers of vaccinations based on information obtained from medical records of vaccinated individuals in the form of electronic vaccination records. Copyright © 2021, EEZY Publishing, s.r.o.. All rights reserved.

Hunting for COVID-19 vaccine.

COVID-19 disease is caused by a novel type of SARS-CoV-2 virus which was firstly described in Chinese Wuhan in December 2019. It is highly infectious disease manifested with fever, respiratory problems, muscle pains and tiredness. Up to now, no efficient medicine has been available, that is why research is focused on development of a vaccine. The vaccine research was launched immediately when the pandemic broke out. The main goal of vaccination against COVID-19 will be prevention of infection outbreak, prevention of reinfection, long-term protective effect and efficiency of vaccination in case of next potential waves of infection. The primary questions are if the effective vaccine against COVID-19 will be developed, how long it will take and who will be the first. The first pandemic disease caused by a novel SARS coronavirus emerged almost 20 years ago, the next MERS coronavirus disease 8 years ago and no effective vaccine against these diseases has been available so far. Presently, 179 candidate vaccines at minimum are at different stages of their development and 18 vaccines are at the stage of clinical evaluation. The surface S glycoprotein SARS-CoV-2 virus is considered the most promising vaccine antigen. Other options are the use of the whole virion or subunit S1 carrier. Currently, four types of potential vaccines have been developed. Whole virion vaccines (attenuated or killed vaccine) vector vaccines (most often using replicating or non-replicating viral vector) protein vaccines (subunit adjuvant vaccine or vaccine based on virus-like particles) and DNA, RNA vaccine. The key moment will be confirmation of the novel vaccine efficiency at the phase 3 of a clinical trial. Despite pressure and efforts to speed up the development of the vaccine, it is realistic to count on the possible vaccine in the year 2021 the earliest and the question is when it can be available in the Czech Republic. Copyright © 2020, Medakta s.r.o.. All rights reserved.

Intracerebral haemorrhage in COVID-19

Most cases of SARS-CoV-2 infection are asymptomatic or have only mild respiratory symptoms. Patients with risk factors, including but not limited to advanced age, obesity, cardiovascular diseases and immunosuppression, may develop a severe course of disease due to the development of a cytokine storm. COVID-19 is associated with an increased risk of bleeding and thromboembolic complications, with the gastrointestinal tract and CNS being among the most frequent sites of bleeding. One of the causes of vessel wall rupture and subsequent bleeding in COVID-19 may be dysfunction of the damaged endothelium. Viral infections are one of the most potent triggers of autoimmune diseases. One of the possible causes of haemorrhagic stroke is virus-induced acute vasculitis.

Vaccination of cancer patients

Cancer patients have an increased risk of infectious complications, the main cause of which is an immunodeficiency condition caused by the cancer itself and its therapy. Therefore, it is appropriate to protect patients by vaccination, in particular vaccination against influenza, pneumococcal infections and covid-19. Appropriately chosen vaccines and the right timing of their administration can as a part of supportive care contribute to the success of cancer therapy.

Type 1 diabetes mellitus as a consequence of Covid-19

The COVID-19 pandemic in 2020 affected the whole world. According to the World Health Organization (WHO), more than 140 million people worldwide have been infected and over 3 million people have died. COVID-19 has affected medicine, education, economics and social life. COVID-19 is caused by the SARS-CoV-2 coronavirus. It belongs to the family Coronaviridae. Six other coronaviruses are known to cause respiratory disease in man. The association between viral diseases and autoimmune diseases is well known, although the exact mechanisms remain unclear. Even the SARS-CoV-2 coronavirus can cause various autoimmune disorders, including type 1 diabetes mellitus. At the University Hospital in Hradec Kralove, we diagnosed new-onset diabetes mellitus in four young patients. © 2021 TIGIS Spol. s.r.o.. All rights reserved.