[Impact of climate changes on the incidence of tick-borne encephalitis in the Czech Republic in 1982-2011]. / Vliv klimatických zmen na výskyt onemocnení klístovou encefalitidou v letech 1982-2011 v Ceské republice.

STUDY OBJECTIVE: To analyse the impact of climate changes on the increase in human cases of tick-borne encephalitis (TBE) in three high-incidence regions of the Czech Republic over the period 1982 to 2011. MATERIAL AND METHODS: Data on TBE cases were derived from the national reporting system EPIDAT. TBE is a reportable infectious disease in the Czech Republic. This study analysed data on TBE cases from three high-incidence regions that vary relatively widely in the average altitude and biotope types. The meteorological data for the study period, obtained from 26 stations of the Czech Hydrometeorological Institute (CHMI) which make standard meteorological measurements, were checked for correctness. The average altitude was determined for each study region. The STATISTICA 6 software was used for the basic statistical analysis (lit.). Pearsons correlation coefficient was used to assess the strength of the relationship between the variables and the 5% level was set as the criterion of statistical significance. The impact of the time lag between the epidemiological and meteorological quantities was also tested. RESULTS: The impact of the meteorological quantities temperature and precipitation rate on the occurrence of 6,229 TBE cases in three administrative regions varying in biotopes, altitude, and epidemiological characteristics of TBE infection was assessed. When evaluating the 30-year period 1982-2011 year by year in three regions, a significant correlation was found between TBE onset and average air temperature in 100%, 90%, and 80% of years, with 11-20-day intervals to the onset of the disease. A significant correlation between the incidence of TBE cases and the precipitation rate was observed for 40%, 43%, and 40% of years. When considering the summary results for the overall study period divided into three seasons (March-April, May-June, July-November), a significant correlation was identified between TBE incidence and temperature in all three seasons, with 0-30-day intervals to the onset, in all three regions. When considering the relationships between TBE incidence, air temperature, and precipitation rate for the overall study period divided into three seasons (March-April, May-June, July-November), a significant correlation was identified between TBE incidence and temperature in all three regions. A correlation between TBE incidence and precipitation rate was only found for the period May-November. Moreover, the impact of air temperature and precipitation rate in the second half of the previous year on TBE incidence in the first half of the following year was tested. A positive correlation between air temperature and TBE incidence in the first half of the following year was found in three regions for 79.3%, 62.1%, and 48.3% of years of the study period. A positive correlation between precipitation rate and TBE incidence was only found in these regions for 3.4%, 17.2%, and 6.9% of years of the study period. CONCLUSIONS: From the study results, it follows that air temperature had a major impact on TBE incidence in the regions studied. A correlation between TBE incidence and precipitation rate was found clearly less often, mostly in summer and autumn months. Air temperature and precipitation rate in the second half of the previous year did not have a major impact on TBE incidence in the first half of the following year.

[Pertussis trend in children under one year of age in the Czech Republic in 1997-2013]. / Trend pertuse u detí do jednoho roku zivota v Ceské republice v letech 1997-2013.

STUDY OBJECTIVE: To characterize the epidemiological situation of pertussis in children under one year of age in the Czech Republic in 1997-2013. MATERIAL AND METHODS: The study cohort consisted of children under one year of age with laboratory confirmed pertussis reported to the communicable disease system from 1997 to 2013. A total of 265 pertussis cases were reported in children under one year of age over the study period. Selected demographic data, need for hospitalization, and vaccination history were evaluated in the study cohort. RESULTS: Children under one year of age have shown a steady upward trend in reported cases of pertussis since the 1990s. The reported incidence of pertussis in this age group was the lowest in 1998 (1.1/100,000 population) and the highest in 2013 (31.3/100,000). In 1997-2013, 265 pertussis cases were reported in children under one year of age, 128 females and 137 males, to the communicable disease system in the Czech Republic. Most of these children, nearly 77%, developed pertussis within the first four months of life. Of the 265 children, 79% were not vaccinated before the onset of the disease and 21% were immunized with at least one dose of pertussis vaccine before developing the disease. As many as 75% of the children with pertussis needed hospitalization. Most of them, nearly 81%, were hospitalized with pertussis in the first four months of life and 90% of them in the first six months of life. CONCLUSIONS: In 1997-2013, an upward trend was observed in pertussis cases in children under one year of age. Most children developed the disease within the first four months of life while not vaccinated against pertussis. This fact unambiguously supports the "cocoon" strategy, i.e. vaccination of the closest contacts of the child, and a booster dose at 25 years of age. At the same time, a question arises whether to provide vaccination to pregnant women.

Incomplete inhibition of phosphorylation of 4E-BP1 as a mechanism of primary resistance to ATP-competitive mTOR inhibitors.

The mammalian target of rapamycin (mTOR) regulates cell growth by integrating nutrient and growth factor signaling and is strongly implicated in cancer. But mTOR is not an oncogene, and which tumors will be resistant or sensitive to new adenosine triphosphate (ATP) competitive mTOR inhibitors now in clinical trials remains unknown. We screened a panel of over 600 human cancer cell lines to identify markers of resistance and sensitivity to the mTOR inhibitor PP242. RAS and phosphatidylinositol 3-kinase catalytic subunit alpha (PIK3CA) mutations were the most significant genetic markers for resistance and sensitivity to PP242, respectively; colon origin was the most significant marker for resistance based on tissue type. Among colon cancer cell lines, those with KRAS mutations were most resistant to PP242, whereas those without KRAS mutations most sensitive. Surprisingly, cell lines with co-mutation of PIK3CA and KRAS had intermediate sensitivity. Immunoblot analysis of the signaling targets downstream of mTOR revealed that the degree of cellular growth inhibition induced by PP242 was correlated with inhibition of phosphorylation of the translational repressor eIF4E-binding protein 1 (4E-BP1), but not ribosomal protein S6 (rpS6). In a tumor growth inhibition trial of PP242 in patient-derived colon cancer xenografts, resistance to PP242-induced inhibition of 4E-BP1 phosphorylation and xenograft growth was again observed in KRAS mutant tumors without PIK3CA co-mutation, compared with KRAS wild-type controls. We show that, in the absence of PIK3CA co-mutation, KRAS mutations are associated with resistance to PP242 and that this is specifically linked to changes in the level of phosphorylation of 4E-BP1.

Whole chromosome instability resulting from the synergistic effects of pRB and p53 inactivation.

Whole chromosome instability (CIN) is a common feature of cancer cells and has been linked to increased tumor evolution and metastasis. Several studies have shown that the loss of the pRB tumor suppressor causes mitotic defects and chromosome mis-segregation. pRB is inactivated in many types of cancer and this raises the possibility that the loss of pRB may be a general cause of CIN in tumors. Paradoxically, retinoblastoma tumor cells have a relatively stable karyotype and currently the circumstances in which pRB inactivation causes CIN in human cancers are unclear. Here we utilize a fluorescence in situ hybridization-based approach to score numerical heterogeneity in chromosome copy number as a readout of CIN. Using this technique, we show that high levels of CIN correlate with the combined inactivation of pRB and p53 and that this association is evident in two independent panels of cancer cell lines. Retinoblastoma cell lines characteristically retain a wild-type TP53 gene, providing an opportunity to test the relevance of this functional relationship. We show that retinoblastoma cell lines display mitotic defects similar to those seen when pRB is depleted from non-transformed cells, but that the presence of wild-type p53 suppresses the accumulation of aneuploid cells. A similar synergy between pRB and p53 inactivation was observed in HCT116 cells. These results suggest that the loss of pRB promotes segregation errors, whereas loss of p53 allows tolerance and continued proliferation of the resulting, genomically unstable cancer cells. Hence, it is the cooperative effect of inactivation of both pRB and p53 tumor suppressor pathways that promotes CIN.

Functionalizing genomic data for personalization of medicine.

The wealth of genomic information currently available to researchers and clinicians has dramatically changed the way some diseases are defined. However, leveraging this information is a major challenge, in part because previously established concepts and tools used for research and development are largely inadequate. Using the example of cancer genomics, this article focuses on systems-biology approaches to inform the development of personalized medicine.

Cluster of three cases of invasive meningococcal disease in a preschool facility in West Bohemia, the Czech Republic.

From 1993 to 2009, there was only one cluster of invasive meningococcal disease (IMD) reported in a community of children in the Czech Republic. This exceptional cluster that occurred in a preschool facility is the focus of this report. In response to the announcement of the disease, anti-epidemic precautions were put in place. Neisseria meningitidis isolates were delivered from local laboratories to the National Reference Laboratory for Meningococcal Infections in Prague. Phenotyping was performed there along with multilocus sequence typing. Related factors and microbiological results were analyzed retrospectively. In October 2009, three girls contracted IMD within a period of 1 week in a 42-member group in a preschool facility attached to the elementary school in Starý Plzenec-Sedlec. In relation to three cases of the disease, another 66 people were registered of which 58 underwent a microbiological examination. N. meningitidis was detected in a total of five (8.6 %) people. The National Reference Laboratory for Meningococcal Infections defined the type of the strain to be C: P1.18-1,34-2,38: F1-7: ST-467 (cc269) and penA27. Tests showed the precise identity of all strains obtained from the three sick children and of two strains contracted through contact with the preschool facility. Despite the complete recovery of all patients with no permanent damage, the need for rapid cooperation between clinical sites, diagnostic laboratories, and epidemiologists was confirmed.

The SRC-associated protein CUB Domain-Containing Protein-1 regulates adhesion and motility.

Multiple SRC-family kinases (SFKs) are commonly activated in carcinoma and appear to have a role in metastasis through incompletely understood mechanisms. Recent studies have shown that CDCP1 (CUB (complement C1r/C1s, Uegf, Bmp1) Domain-Containing Protein-1) is a transmembrane protein and an SRC substrate potentially involved in metastasis. Here we show that increased SFK and CDCP1 tyrosine phosphorylation is, surprisingly, associated with a decrease in FAK phosphorylation. This appears to be true in human tumors as shown by our correlation analysis of a mass spectrometric data set of affinity-purified phosphotyrosine peptides obtained from normal and cancer lung tissue samples. Induction of tyrosine phosphorylation of CDCP1 in cell culture, including by a mAb that binds to its extracellular domain, promoted changes in SFK and FAK tyrosine phosphorylation, as well as in PKC(TM), a protein known to associate with CDCP1, and these changes are accompanied by increases in adhesion and motility. Thus, signaling events that accompany the CDCP1 tyrosine phosphorylation observed in cell lines and human lung tumors may explain how the CDCP1/SFK complex regulates motility and adhesion.

Sixty years of research of tick-borne encephalitis--a basis of the current knowledge of the epidemiological situation in Central Europe.

Tick-borne encephalitis (TBE) virus was isolated for the first time in Central Europe in 1948 from both a patient and Ixodes ricinus ticks collected in the area where the patient had been tick bitten (the Beroun area - Central Bohemia) and concomitantly from a TBE patient in Moravia (the Vyskov area). Another priority discovery was alimentary transmission of TBE virus via the milk from tick infected grazing goats that was made during a TBE outbreak in Roznava (SE Slovakia). This outbreak of 660 cases has been the largest of its kind. Both of these discoveries were a challenge to multidisciplinary research into the natural focality of TBE. The results obtained were published by Czech and Slovak authors in the first European TBE monograph (1954) and were the stimulus for further research in this area. From the epidemiological point of view, among others, the impact of meteorological factors (on TBE incidence associated with I. ricinus host-seeking activity) and recreational nature of TBE were clearly defined then. At the same time, TBE became a notifiable disease (since 1971 laboratory confirmed TBE cases only). In the following decades, the phenomenon of natural focality of TBE (including anthropic impacts) was extensively studied and the determinants of high-risk areas in the field were analyzed. The results were used in the creation of I. ricinus and TBE risk prediction maps for the Czech Republic generated for the first time in Europe using LANDSAT 5 satellite data and GIS technology (1990). In the early 1990s (in particular since 1993), similarly to other countries, the Czech Republic reported a sharp rise in TBE cases that continues, with some fluctuations, until now. The cooperation with climatologists in the analysis of historical data, current epidemiological observations, and study of I. ricinus in the field have shown a decisive impact of the ongoing climate change. The analysis of the socio-economic conditions in high-risk areas for TBE has not revealed any impact of these conditions on TBE morbidity. The recreational factor that is influenced by the weather changes has a considerable impact. The seasonal trend of TBE cases shows large fluctuations as were seen in 2006, 2009, and 2010, also as a result of weather changes with seasons. This clearly implies the need for using long time series of data, covering at least a decade, to be able to draw general conclusions as is the case in the present study (2001-2010). The data broken down by Administrative Region display substantial interregional differences. Of 14 Administrative Regions of the Czech Republic, three exhibits a linear trend in TBE incidence, with a minimum deviation from the baseline, four Regions show different downward linear trends, but seven Regions display different upward trends. The upward trend is most obvious in the Highlands (Vysocina) Region where it is associated with the prevalent orographic conditions and increase in the incidence of I. ricinus ticks at higher altitudes. The knowledge of the area where the patient was tick bitten that is entered in the Epidat database as the "probable area of TBE infection acquisition" is helpful in identifying high-risk areas for TBE. By matching the area of TBE acquisition with that of the patient's domicile we revealed that TBE patients had to travel to areas other than their area of domicile to acquire TBE and thus also significance of the areas of TBE acquisition at the country level. The population of the Prague Region (NUTS3 CZ010) can be used as an illustrative example, with 37.7% of TBE cases only reported to be acquired in the Prague Region while 33.4% of TBE cases were associated with travel to the Central Bohemian Region and 13.9% of TBE cases were imported from the South Bohemian Region (the rates of TBE cases imported from other Regions were less than 5%). And conversely, the residents of the South Bohemian Region (CZ031), with the highest number of TBE cases ever in the Czech Republic, acquired TBE in the region of domicile at a rate of 99.5%. These rates are clearly associated with the recreational potential of various Regions. The probable area of TBE acquisition is identified by cadastral community. In the light of the natural focality of TBE, the analysis of the local environmental factors involved in the circulation of TBE virus in the wild environment is required to determine the high-risk areas and local risk level. Although outbreaks of TBE cases in humans are indicative of TBE natural foci, more data is needed to delineate such areas. And similarly, the absence of TBE cases in humans over a period of time may not be indicative of a no risk area.

A steady rise in incidence of pertussis since nineties in the Czech Republic.

STUDY OBJECTIVE: The objective was to analyze the incidence and trends of pertussis in the Czech Republic, particularly by age groups. An important part of the analysis was the immunization coverage. MATERIALS AND METHODS: The incidence data were obtained from the following information sources: archives of the National Institute of Public Health for the period up to 1964, archives of the Institute of Health Information and Statistics for 1965-1981, Communicable Disease Information System for 1982-1992 and Communicable Disease Notification System EPIDAT for 1992-2008. The mortality data were obtained, apart from the aforementioned sources, also from the literature. The case definition was based on that provided by the Bulletin of the Ministry of Health and the EC Directive. Cases were notified in accordance with the guidelines of the respective information systems and the principles of pertussis surveillance laid down by the regulations. An epidemiological investigation form was filled in for each case of pertussis, indicating the type of laboratory analysis. The methods used for laboratory diagnosis of pertussis were culture, serology and a PCR assay. RESULTS: An upward trend in notified cases of pertussis has been observed since the 1990s. The highest annual number of cases (767) in the last 42 years was notified in 2008 (7.3/100,000 population). In 1988-2008, most (93.1%) cases were notified in patients aged 0-19 years. During this period the peak moved from the youngest and preschool age groups toward younger and older school age children (the highest age-specific incidence of pertussis, i.e., 79.8/100,000, was observed in 10-14-year-olds. In 2008, a 3.4 fold rise in pertussis cases was observed in 15-19-year-olds as compared with the rates in the last six years. More cases were also notified in the age groups of potential parents and grandparents. In the 0- year-old children, the incidence of pertussis was decreasing since the 1950s (3804.9/100,000 in 1956) to remain under 10.0/100,000 between 1974 and 1999. It showed a continuing upward trend from 3.8/100,000 in 1987 to 26.7/100,000 in 2008, even with three deaths notified, after 35 years, in 2005, 2007 and 2009. CONCLUSION: Despite the high immunization coverage with pertussis vaccine (>97%), the pertussis incidence is rising in the Czech Republic. An upward trend in pertussis cases has been observed since 1993, peaking in 2008. More than 75 % of pertussis cases were notified in patients who had been vaccinated with 5 doses of pertussis vaccine before infection. During the period 1988-2008, the highest age-specific incidence, i.e., 79.8/100,000, was observed in 10-14-year-olds. After 35 years, three deaths from pertussis were notified in 2005, 2007 and 2009. All three fatal cases occurred in unvaccinated children under one year of age. The focus needs to be on active surveillance of pertussis and quality improvement of all its parts.

Alimentary transmission of tick-borne encephalitis in the Czech Republic (1997-2008).

OBJECTIVES: Analysis of cases of tick-borne encephalitis (TBE) with confirmed food-borne transmission in patients who were unaware of tick attachment prior to the onset of illness. MATERIAL AND METHODS: Data on laboratory confirmed cases of TBE reported in the Czech Republic (CR) in 1997-2008 were obtained from the EPIDAT system. Patient interview data were recorded in a standardised questionnaire form with multiple choices for locality (GIS) and route of transmission to be exported on a weekly basis in electronic form to a protected database of the Ministry of Health of CR. Statistical processing was conducted by ANOVA using Epi-Info CDC Atlanta and STATCALC software. RESULTS: TBE has been recognised in CR since 1948 when, for the first time ever in Europe, the TBE virus was isolated from patients and I. ricinus ticks in two Czech and Moravian areas simultaneously (and independently of one another). TBE cases in the Czech Republic have been reported since 1971. In 1997 - 2008 the incidence ranged between 422 cases (1998) to 1029 cases (2006). Food-borne transmission of TBE was first reported in Czechoslovakia in 1954. At that time, nothing was known of the possibilities of arbovirus transmission by the food-borne route; this was discovered following the TBE epidemic of 1951 in the east Slovak town of Roznava in which 660 persons were infected, and of these, 271 were hospitalised. The source of infection was contaminated goats' milk which had been mixed into dairy milk at the local dairy and distributed without pasteurization. The risk of TBE transmission by unpasteurized goats' milk is associated with the current trend of I. ricinus tick proliferation in foothills and mountainous areas. The shift of the line of their spread from 700 m above sea level to 1200 m means that to up to 8% of the area of the CR (6300 km2) have been newly colonized by ticks. In 1997 - 2008, 64 cases of TBE were recorded in patients who reported consumption of unpasteurized goats' and dairy milk or unpasteurized sheep's milk cheese. The majority of cases involved goats' milk (36 patients, i.e. 56.3%) and sheep's milk cheese (21 patients, i.e. 32.8%). Dairy milk-borne infection was responsible for 7 TBE cases (10.9%). Of the 64 patients with food-borne TBE, 33 were men (51.6%) and 31 women (48.4%). Thirty-three cases (51.6%) occurred in family outbreaks following purchase of cheese or milk from animal breeders. Twenty-two cases (34.4%) occurred in individual patients and for 9 cases (14.0%) the data are unavailable. The highest age-specific morbidity, i.e. 1.94/100 000, was observed amongst the 5 - 9 years age-group, while in the adult age-groups the rates ranged between 0.17/100 00 (75+ years) and 0.89/100 00 (35 - 44 years). The comparison of TBE cases in child and adult age groups revealed that children in the food-borne TBE group had a 2.5 fold risk of TBE infection over adults. None of the TBE patients was vaccinated against TBE. CONCLUSION: In 1997 - 2008, a total of 7288 cases of TBE were reported. Sixty-four (0.9%) TBE cases were food-borne. In the majority of these cases, TBE virus was transmitted by unpasteurized goats' milk and caused family outbreaks. The deciding factor in these outbreaks was an attempt to provide healthy diet to offspring.

Increase in hepatitis A cases in the Czech Republic in 2008 - an update.

In 2008, 1,616 cases of hepatitis A were reported in the Czech Republic, more than a 10-fold increase compared with the annual number of cases registered in 2003-2007. The infection was initially associated with injecting drug users, most probably by person-to-person contact or parenteral transmission, and in the second half of the year continued to spread among the general population with increased susceptibility.

Incidence of invasive pneumococcal disease in the Czech Republic and serotype coverage by vaccines, 1997-2006.

We studied the incidence of invasive pneumococcal disease (IPD) in the Czech Republic by analysing two sources of data. The incidence of pneumococcal meningitis based on routine notification data varied between 0.4 and 0.6/100 000 population between 1997 and 2006. The incidence of IPD based on laboratory surveillance varied between 2.3 and 4.3/100 000 population between 2000 and 2006. The annual IPD incidence remained stable during the study period. Estimates of absolute IPD case-load in the entire country varied from 235 to 437 per year. The age-specific incidence was highest in the <1 year age group, reaching 4.3/100 000 for pneumococcal meningitis in routine notification and 15.7/100 000 for IPD in laboratory-based surveillance data, respectively. A total of 1236 Streptococcus pneumoniae isolates from cerebrospinal fluid and sterile body sites were investigated. The most frequent serotypes causing IPD in all ages were 3, 4, 14, 8 and 19F, accounting for 41.5% of all isolates. The most frequent serotypes by age group were: <1 year (6B and 19F); 1-4 years (14, 6B and 23F); 40-64 years (3, 8 and 4), and > or = 65 years (3, 4, 9N and 14). The coverage of serotypes in all age groups by pneumococcal vaccines ranged from 41.5% for 7-valent conjugate vaccine to 67.9% for 13-valent conjugate vaccine. The coverage of serotypes causing IPD is significantly different between infants/children and adults/elderly. PCV-7 coverage by age group was: <1 year (66.0%), 1-4 years (65.1%), 40-64 years (34.4%) and > or = 65 years (39.3%). Similar age differences between infants/children and adults/elderly were found in coverage by PCV-9, PCV-11 and PCV-13. The distribution of serotypes in the total population and individual age groups was stable during the period 2000-2006.

Changes of meteorological factors and tick-borne encephalitis incidence in the Czech Republic.

OBJECTIVES: The primary objective was to analyze the influence of short-term meteorological changes during the vegetation period on the incidence of tick-borne encephalitis (TBE) in the 1990s, characterized by a dramatic increase in reported TBE cases in the Czech Republic and other European countries. Furthermore, the relationship between TBE incidence and meteorological conditions in the previous winter season was studied. MATERIAL AND METHODS: The TBE incidence data were acquired from the EPIDAT database of the National Institute of Public Health (NIPH). Analyzed were a total of 4637 cases reported in Bohemia (1994-2004). Meteorological data were from the database of the Czech Hydrometeorological Institute in Prague and originated from 22 meteorological stations located in high TBE incidence areas in Bohemia. RESULTS: A linear relationship was found between TBE incidence and temperature factors in all the years under study. Lagged cross-correlation analysis (with the time lag corresponding to the incubation period from the infected tick bite to the onset of TBE symptoms) revealed a close correlation between TBE incidence and weekly mean air temperature with a lag of 1 to 5 weeks. When considering the previous winter period, the closest relationship was found between TBE incidence and the previous-winter frost index, followed by the minimum air temperature. CONCLUSION: A review is presented of the effects of the currently observed climate change on TBE incidence as compared with the data reported in the 1950s. Results of parallel analyses of other factors potentially implicated in higher TBE incidence in the 1990s lead to a critical rejection of the conclusion previously drawn by some authors that the collapse of communism and subsequent dramatic socio-economic changes might have a decisive influence on TBE incidence in Central Europe. The rise in TBE cases reported in West European countries where no such political changes took place confirms the refutation.

Increase in hepatitis A cases in the Czech Republic in 2008--preliminary report.

The public health protection authorities in the Czech Republic report a rise in cases of viral hepatitis A (HAV) since the end of May 2008. In total, as many as 602 HAV cases have been reported in 2008 until the end of calendar week 39 (28 September).

An increase in the number of mumps cases in the Czech Republic, 2005-2006.

The Czech Republic has had a two-dose measles, mumps and rubella (MMR) vaccination programme since 1987. The last outbreak of mumps was reported in 2002, but an increase in the number of mumps cases was observed in 2005, starting in October that year. We analysed routinely collected surveillance data from 1 January 2005 to 30 June 2006 to show the magnitude of the increase and describe the most affected groups in order to better target prevention and control strategies. In the 18-month period examined, 5,998 cases of mumps were notified, with a peak incidence in May 2006. No deaths were recorded, but 21% of cases were hospitalised. Incidence was lowest in the Plzen region (1.9/100,000) and highest in Zlin (118.6/100,000). There were more male (61.8%) than female cases. The age of the cases ranged from 0 to 80 years. The highest incidence rate was observed in the age group of 15 to 19 years, in which 87% of cases had received two doses of mumps vaccine. The average age of unvaccinated cases was 22.9 years, while for cases vaccinated with two doses it was 14.5 years. Although vaccine effectiveness could not be calculated from the data available, possible reasons for highly-vaccinated cases occurring are discussed.

[Invasive pneumococcal disease in the Czech Republic in 2000-2006]. / Invazivni pneumokokové onemocemní v Ceské republice v letech 2000-2006.

STUDY OBJECTIVE: To assess the incidence of invasive pneumococcal disease and coverage of the causative serotypes by pneumococcal vaccines in the Czech Republic. METHODS: The incidence and fatality rates of reported cases of pneumococcal meningitis (EPIDAT) in 1997-2006 are analyzed. In addition, the data of the National Reference Laboratory for Streptococci and Enterococci from 2000-2006 are presented. The incidence of invasive pneumococcal disease was calculated for the catchment population of the collaborating laboratories. Pneumococcal typing was performed in the National Reference Laboratory. The percentages of pneumococcal serotypes isolated from invasive disease in 2000-2006 and included in the pneumococcal vaccines were calculated. RESULTS: The incidence of invasive pneumococcal disease ranged from 2.30 to 4.28/100000 population. The age-specific incidence of invasive pneumococcal disease in 2000-2006 was the highest in the lowest age groups 0-11 months (15.75/100000) and 1-4 years (8.22/100000), followed by the age group of 65 years and older (7.3/100000). The total fatality rate of pneumococcal meningitis in 1997-2006 was 13.7%. The highest age-specific fatality rate was recorded in 65-year olds and over (24%). In the age group 0-11 months, the coverage of pneumococcal serotypes is 66% by the 7-valent conjugate vaccine, 76% by the 10-valent conjugate vaccine and 82% by thel3-valent conjugate vaccine. In the age group 1-4 years, the respective rates are 65.1%, 76.4% and 85.8%. The coverage of serotypes by conjugate vaccines is higher in the youngest age groups (0-11 months and 1-4 years) compared to adults (40-64 years and 65 years and older). CONCLUSION: Based on laboratory data, the incidence of invasive pneumococcal disease in the Czech Republic in 2000-2006 is comparable with the rates reported in other European countries. The highest incidence rates were observed in the youngest age groups. The distribution of serotypes causing invasive pneumococcal disease differs between children and adults. The coverage of serotypes by conjugate pneumococcal vaccines is higher in children (66-65%) compared to adults (34-65%). It is desirable to launch a nationwide programme of surveillance of invasive pneumococcal disease. Furthermore, it is recommended that a conjugate pneumococcal vaccine should be included in the children's immunization schedule.

[Imported viral hepatitis in the Czech Republic]. / Importované virové hepatitidy v Ceské republice.

OBJECTIVE: Through the analysis of notified viral hepatitis, trends in the occurrence of imported cases in the Czech Republic have been specified, the aim of which was to draw attention to the epidemiologically important aspects of travelling abroad. MATERIAL AND METHODS: In the software environment of Epi Info version 6.04d, nationwide databases of communicable diseases over the period of 1993-2005 were analysed. The period was defined with respect to the availability of necessary data in the Epidat information system for communicable disease reporting in the Czech Republic. RESULTS: During the years 1993-2005, 12,091 cases of communicable diseases were imported into the Czech Republic of which viral hepatitis accounted for 5.7 % (685). The rates by diagnosis were as follows: viral hepatitis A 61 %, acute viral hepatitis B 15 %, chronic viral hepatitis C 11 %, viral hepatitis E 5 %, acute viral hepatitis C 3 %, chronic viral hepatitis B 3 % and other cases of viral hepatitis 2 %. The rates by the "imported by" variable: Czech tourists 47.2 %, foreigners 32.8 %, Czech business travellers 20.0 %. The diseases were most commonly imported from the following countries: Ukraine 13 %, Slovakia 8 %, Southern Europe 6 %, Egypt 6 % and Russia 5 %. CONCLUSION: In the Czech Republic, communicable diseases are reported using the Epidat system. The Epidat database analysis focused on reported cases of imported viral hepatitis represents an important starting point for assessing health risks associated with travelling abroad.

[Pertussis: a reemerging infection?]. / Pertusse--navracející se infekce?

STUDY OBJECTIVES: To analyze the incidence of pertussis in the Czech Republic, influencing factors and, in particular, the effect of vaccination on pertussis morbidity, clinical seriousness of the disease and circulation of Bordetella pertussis in the population. To study the causes of defective diagnosis and reporting and to propose remedial measures. METHODS: Data on pertussis morbidity were obtained from the archives of the National Institute of Public Health and the public health information systems ISPO and EPIDAT. Mortality data were taken from the above sources and literature. The case definition was used as specified in the Methodical Guidance for Pertussis Surveillance and the EC Directive. Laboratory diagnosis was based on culture and serology. An at least fourfold increase in the serum antibody titer found within an experiment was considered as a positive result. RESULTS: Pertussis together with diphteria and measles used to be among the most dangerous infections in childhood. The oldest mortality data date back to 1890 when 62 deaths per 100,000 population were reported. In 1951, the death rate still reached 3.6/100,000. The pertussis morbidity peaked in 1955 with 540 cases per 100,000 population. Vaccination against pertussis since the early 1950's led to a rapid reduction of morbidity in children. Nevertheless, higher pertussis morbidity rates were observed at 2-4-year intervals (in the so- called epidemic years). The lowest morbidity rates were reported during the 1980's. However, a stable upward trend has been observed over the following years. In 2006, a neonate died from pertussis. The age specific morbidity rates in 1980 through 2000 were highest in children under one year of age. This fact together with the regularly increased morbidity rates observed at 2-3-year intervals indicate that Bordetella pertussis still circulates in the population. While in the 1980's, the cases of pertussis were reported almost exclusively in children under one year of age, in the 1990's, they became more common also among children 1-4 years of age and started to be prevalent in children 10-14 years of age since 2001. CONCLUSION: A high immunisation coverage (97%) with five doses of high quality whole-cell vaccine of Czech origin introduced into practice in 1958 played a crucial role in the reduction of pertussis morbidity from more than 500/100,000 in the mid-1950's to less than 0.5/100,000 in the 1980's. Nevertheless, this strategy did not lead to elimination of the causative agent in the population. It is evident that the current immunization scheme with the use of the available vaccines cannot solve the epidemiological situation. Since the efficacy of the currently available acellular pertussis vaccines is, at the best, the same as that of the whole-cell vaccines, any improvement of the current status cannot be expected. Only effective active surveillance, the use of new more immunogenic pertussis vaccines and revaccination of older age groups can result in desirable outcomes.

[Notified cases of imported transmisssible infections in the Czech Republic]. / Notifikované importované prenosné nákazy v Ceské republice.

OBJECTIVES: Based on analysis of epidemiological characteristics, to determine trends in the incidence of imported transmissible diseases in the Czech Republic and to draw attention to the epidemiological significance of international tourism and migration. MATERIAL AND METHODS: In cooperation with the National Reference Centre for Epidemiological Data Analysis, National Institute of Public Health Prague, the nationwide Epidat information system databases from 1993 to 2005 were analyzed using software Epi Info version 6.04d. RESULTS: Between 1993 and 2005, altogether 12,091 cases of transmissible diseases were imported into the Czech Republic from 168 countries in the world. The notified annual incidence of imported infections ranges from 206 to 1,714 cases. The highest percentage of cases was imported by Czech tourists (50.7 %) while 40 % of the notified cases were imported into the Czech Republic by foreigners. The period 1998-2004 for which the data on Czech tourism to other countries are available is characterized by increase in the absolute number of imported cases while the relative incidence of imported cases per 100,000 population traveling to other countries shows a downward trend. The highest numbers of cases were imported from Viet Nam (1,258 cases), Slovakia (1,155 cases) and India (786 cases). When considering Czech tourism to other countries for which the corresponding data are available, the highest rates of imported diseases in 1998-2004 were linked to the travels to Tunisia (1.18 imported cases per 1,000 tours), Bulgaria (0.69 per 1,000 tours) and Turkey (0.65 per 1,000 tours). The leading diagnosis of imported cases was salmonellosis (22%), followed by campylobacteriosis (10%) and trichuriasis (8%). CONCLUSION: Analysis of the Epidat information system databases for reporting transmissible diseases enables assessment of trends in imported infections in the Czech Republic as a point of departure for estimation of health risk from tourism and migration.