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.

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.

A haemochromatosis-causing HFE mutation is associated with SARS-CoV-2 susceptibility in the Czech population.

BACKGROUND: Coronavirus disease (COVID-19), which is caused by the SARS-CoV-2 virus, has become a global pandemic. While susceptibility to COVID-19 is subject to several external factors, including hypertension, BMI, and the presence of diabetes, it is also genetically determined to a significant extent. Infectious agents require iron (Fe) for proper functioning. Carriers of mutations resulting in increased iron concentrations are understood to be at increased risk of COVID-19. METHODS: We examined HFE genotypes associated with hereditary haemochromatosis (rs1800562 and rs1799945 SNPs) in 617 COVID-19 patients (166 asymptomatic, 246 symptomatic and 205 hospitalised survivors) and 2 559 population-based controls. RESULTS: We found a higher frequency of the minor allele (Tyr282) of the rs1800562 polymorphism (P < 0.002) in patients compared to controls (8.5 % vs 5.5 %). Non-carriers of the minor allele were protected against SARS-Cov-2 infection (OR, 95 %CI; 0.59, 0.42-0.82). The frequency of minor allele carriers was almost identical across asymptomatic, symptomatic, and hospitalised survivors. The rs1799945 variant did not affect disease severity and its occurrence was almost identical in patients and controls (P between 0.58 and 0.84). CONCLUSIONS: In conclusion, our results indicate that presence of the rs1800562 minor allele, which is associated with hereditary haemochromatosis (thus increased levels of plasma Fe), increases susceptibility to SARS-CoV-2.

COVID-19 vaccination decrease the risk of Intensive Care Unit hospitalisation in heart failure patients even in the time of Omicron variant: population based study

Background: Heart failure (HF) patients, especially those in higher age, are at high risk of severe course of COVID-19. Purpose: The aim of this work was to compare the risk of the necessity of intensive care being provided in the Intensive care units in HF patients with and without COVID-19 vaccination in the time of Omicron variant. Methods: The analysis was done on data from the National Health Information System, which was supplemented with data from the Information System of Infectious Diseases. Results: At the beginning of 2022, we estimate a total of 128,848 HF patients. Of these, 52.5% were men, mean of age (±SD) was 71.8 (±11.6) years, mean of age of women was 78.2 (±10.7). In January 2022, 560,886 cases of COVID-19 were diagnosed in the Czech Republic (5,241.1 cases per 100,000 population), the mean of the age was 32.5 (±18.3) years. At this time, the Omicron variant prevailed in the Czech Republic. Total 1,667 COVID-19 cases were HF patients, 56.3% were men. Not vaccinated were 420 patients, vaccinated without booster were 556 patients and vaccinated with booster were 691 patients. The risk of hospitalisation within 14 days from COVID-19 diagnosis was 46.7% (95% CI 41.5%;51.8%) in not vaccinated group, 37.0% (32.9%;41.2%) in vaccinated group and 22.6% (19.8;26.0%) in vaccinated with booster group. The risk of the necessity of intensive care being provided in the Intensive care units was 11.1% (7.7%;14.5%) in not vaccinated group, 4.7% (2.8%;6.6%) in vaccinated group and 3.7% (2.0%;5.4%) in vaccinated with booster group (Figure 1). Conclusion: COVID-19 vaccination decrease the risk of Intensive Care Unit hospitalisation in heart failure patients even in the time of Omicron variant. Funding Acknowledgement: Type of funding sources: Public hospital(s). Main funding source(s): The Ministry of Health of the Czech Republic – conceptual development of research organisation (FNBr, 65269705;funding was given to University Hospital Brno)Figure 1

Complete coverage by examinations: relationship to colorectal cancer burden and the COVID-19 : Ondrej Ngo

Background Colorectal cancer (CRC) is among the most common cancers and cancer causes of death worldwide. CRC screening and early detection is essential to reduce CRC incidence and mortality. CRC screening has been initiated in the Czech Republic in 2000 for persons over 50 and currently offers a faecal occult blood test (FOBT) or screening colonoscopy (CS). The aim of our study was to present complete coverage by examinations in relation to the trends in CRC burden and impact of COVID-19. Methods We defined the complete coverage by examinations as the proportion of persons aged over 50 undergoing examination with CRC early detection potential (FOBT or CS for any indication) during past 3 years. Standardized incidence and mortality rates were used to assess epidemiological trends. The impact of COVID-19 was assessed for 2020 and 2021 by comparing the volume of examinations with 2019. We used national health registries (National Registry of Reimbursed Health Services, Czech National Cancer Registry) as the source of data. Results Complete coverage was increasing over time and reached around 50% in recent years (target population is more than 4 million persons, most of the performed examinations were screening FOBT). However, coverage has decreased to 47.9% in 2020. In 2020 and 2021, the number of tests performed decreased by 16.9% and 5.5%, respectively, compared to 2019. CRC incidence and mortality rates have decreased by more than 20% and almost 30%, respectively, in the last decade. Conclusions Complete coverage has reached a satisfactory level and has likely a positive impact on the epidemiological trends. However, further action is needed to increase coverage, recently affected by COVID-19 pandemic, when non-acute health care may have been neglected. Key messages • The long-term high level of coverage by examinations likely has a positive impact on CRC burden. • The observed decrease in coverage caused by COVID-19 needs to be appropriately compensated.

CCR5Delta32 deletion as a protective factor in Czech first-wave COVID-19 subjects

Infection by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus that causes coronavirus disease (COVID-19), has spread widely around the globe. Significant inter-individual differences have been observed during the course of the infection, which suggests that genetic susceptibility may be a contributing factor. CC chemokine receptor 5 (CCR5), which acts as a co-receptor for the entry of HIV-1 into cells, is promising candidate whose can have an influence on SARS-CoV-2 infection. A genetic mutation known as CCR5Delta32, consisting of a 32-nucleotide deletion, encodes a truncated protein that protects homozygous carriers of the deletion from HIV-1 infection. Similarly, inhibition of CCR5 seems to be protective against COVID-19. In our study, we successfully genotyped 416 first-wave SARS-CoV-2-positive infection survivors (164 asymptomatic and 252 symptomatic) for CCR5?32, comparing them with a population based sample of 2,404 subjects. We found the highest number (P=0.03) of CCR5Delta32 carriers in SARS-CoV-2-positive/COVID-19-asympto-matic subjects (23.8 %) and the lowest number in SARS-CoV-2-positive/COVID-19-symptomatic patients (16.7 %), with frequency in the control population in the middle (21.0 %). We conclude that the CCR5?32 I/D polymorphism may have the potential to predict the severity of SARS-CoV-2 infection.