Characteristics of homeless persons hospitalized in health care facilities in the Czech Republic in 2006-2015.

AIM: Homelessness is a social, societal, economic, and health problem. The aim of the study was to describe the characteristics of hospitalized homeless persons in the Czech Republic in relation to their health status and to propose targeted measures for improvement. MATERIAL AND METHODS: The study used anonymous data from the National Registry of Hospitalized Patients from 2006-2015, including the primary diagnosis at hospital admission and up to five additional diagnoses according to the 10th revision of the International Classification of Diseases (ICD-10). The basic statistical unit is the completed case of hospitalization of a homeless person in an inpatient health care facility such as hospital or nursing home. RESULTS: Over the 10-year study period (2006-2015), 3387 homeless persons, 77.5% of them male, were admitted to inpatient health care facilities in the Czech Republic. The length of hospital stay tended to decrease over the years, with a median of six days. The majority of hospitalized homeless persons were aged between 40 and 69 years. Their distribution by type of health care facility: 2,710 (80.0%) were admitted to hospitals, 468 (13.8%) to psychiatric hospitals, 180 (5.3%) to long-term care facilities, and 29 (0.9%) to tuberculosis and respiratory disease hospitals. According to the mode of termination of hospitalization, 2189 (64.6%) homeless persons were discharged to their original environment, 280 (8.3%) were transferred to an after-care facility, 277 (8.2%) were transferred to an acute care facility, 222 (6.6%) left against medical advice, 180 (5.3%) were transferred to another ward, and 80 (2.4%) were transferred to a social care facility. A total of 159 (4.7%) in-hospital deaths occurred. The underlying causes of hospitalization according to ICD-10 were mostly those under Chapter V - Mental and behavioural disorders (19.9%) and Chapter XIX - Injury, poisoning and certain other consequences of external causes (18.1%). Among the 175 cases with a primary diagnosis from Chapter I - Certain infectious and parasitic diseases, the most common conditions were scabies, pediculosis, mycosis, bacterial infections, and tuberculosis. CONCLUSION: Data on hospital admissions is one of the important tools for monitoring the health of homeless people. They illustrate the seriousness of the situation of homeless people and point to the need to obtain more information on this issue in order to improve the availability of specific health care and social care for sick homeless people. Prevention programs, residential services, and specific outreach health and social activities can contribute to reducing the negative impacts.

Comparison of the epidemiological patterns of Lyme borreliosis and tick-borne encephalitis in the Czech Republic in 2007-2016.

BACKGROUND: Lyme borreliosis (LB) and tick-borne encephalitis (TBE) are two vector-borne diseases transmitted by ticks. Both diseases are endemic and have been reported in all regions of the Czech Republic including urban agglomerations, but in varying proportions. Because of the natural conditions in the border areas, the risk of infection is also high for travelers from the neighboring countries such as Austria, Germany, Poland, and Slovakia. MATERIALS AND METHODS: To gain more information on the epidemiology of LB and TBE in the last decade, we analyzed national surveillance data from 2007 to 2016. RESULTS: Incidence of LB in the Czech Republic was 37.3/100,000 population and year (27.6 - 46.1/100,000). Incidence of TBE incidence was 5.7/100,000 (3.4-8.2/100,000) and declined although the trend was not significant (p = 0.155). Difference between the incidences of LB and TBE was increasing in time. Overall male-to-female ratio was 0.84 and 1.51 for LB and TBE, respectively. The age-specific incidences of both infections have a typical two-peak shape, with the first peak in the age group 5-9 years for LB and 15-19 years for TBE. The second peak for both LB and TBE is in the age group 55-64 years. TBE poses a considerable risk to children < 15 years. Among 39,074 cases of LB, the most common clinical manifestations were erythema migrants 62.1% and Lyme neuroborreliosis 25.1%. All 5969 TBE cases manifested itself by affecting nervous system, namely meningo-encephalitis 47.9%, meningoencephalomyelitis 21.8% and meningitis 19.8%. CONCLUSIONS: The data evidence the high chance risk of infection with LB and TBE in the Czech Republic. The incidence of both infections shows a bimodal distribution during the year. LB cases are five to six times as frequent as TBE cases. Over the last years, the incidence of LB has remained roughly stable while TBE has shown a downward trend. The present study is unique in allowing the comparison of the incidence rates of LB and TBE over time and space.

Neuroborreliosis in patients hospitalised for Lyme borreliosis in the Czech Republic in 2003 - 2013.

STUDY OBJECTIVE: The objective was to analyse and evaluate a cohort of Lyme borreliosis (LB) patients with neuroborreliosis (LNB) hospitalised in the Czech Republic in 2003-2013. MATERIAL AND METHODS: Data analysed in this study were obtained from the National Register of Hospitalised Patients, which is a nationwide population register maintained at the Institute of Health Information and Statistics of the Czech Republic. Data collection from all departments of bed care establishments are regularly processed every year. Registration of basic hospitalisation diagnoses is performed in accordance with the 10th revision of the International Classification of Diseases (ICD-10). The study cohort consisted of 23,631 patients with clinically and laboratory confirmed LB hospitalised between 2003 and 2013. RESULTS: Nervous system involvement, i. e. LNB (ICD-10 codes G00-G99) was recorded in 27.1% (6,392) of LB patients. Hospital admissions for LB exhibited a slight downward trend with year-on-year fluctuations over the study period. In contrast, LNB showed an upward trend with slight year-on-year fluctuations (345-779 cases) (p = 0.003). Overall, 6,392 persons, 3,220 males and 3,172 females, were diagnosed with LNB over the 11-year study period. Some patients presented with multiple concomitant neurological symptoms. Overall, 6,392 hospitalised patients were diagnosed with 8,168 diseases of the nervous system. The most common diagnoses were facial nerve disorders (21.1%), meningitis (18.3%), polyneuropathies (13.6%), encephalitis, myelitis, and encephalomyelitis (11.3%), and nerve root and plexus disorders (4.9%). The average age of male and female patients hospitalised with LNB was 44.4 and 44.7 years, respectively. It varied significantly between the ICD-10 code groups (p < 0.001) from 38.0 to 63.0 years. The relative incidence of LB by five-year age group showed the first peak at the age of 5-9, followed by a considerable drop at the age of 20-24 and then by another higher peak at the age of 55-59 (the hospitalisation rate ratio comparing the peaks in the adults and children was 1.78). For LNB, the second peak shifted to the age of 65 to 74 years and was similar to the peak in children age groups (hospitalisation rate ratio of 0.95). The distribution of hospital admissions for LNB by month of admission showed the highest numbers of admissions in July and September and the lowest numbers of admissions in December and April. The length of hospital stay was significantly higher (mean of 12.4 days and median of 13 days) in LNB patients (p < 0.001) than in other LB patients (mean of 10.3 days and median of 10 days). CONCLUSION: The basic prerequisite for reliable diagnosis of LNB is a multidisciplinary collaboration of highly experienced neurologists, infection disease specialists, and microbiologists. The cohort of 6,392 patients hospitalised for LNB was analysed by gender, length of hospital stay, and month of hospital admission. The study found LNB cases to occur in all age groups. LNB diagnosis performed in accordance with the ICD-10 enables valid comparison between neurological outcomes of LB patients at both the national and international levels.

[The prevalence of antibodies against Hepatitis E Virus in the Czech Republic: serological survey]. / Prevalence protilátek proti viru hepatitidy E v Ceské republice - sérologický prehled.

AIM: To determine the prevalence of antibodies against hepatitis E virus in the general population of the Czech Republic of age 15 to 64, to analyse the age and sex distribution of these antibodies, and to evaluate the benefit of the immunoblot test for the confirmation of the specificity of the enzyme immunoassay (EIA) screening test. MATERIAL AND METHODS: Sera from the last available multipurpose serological survey conducted in 2001 were tested. Anti-HEV IgG was detected by the RecomWell HEV IgG EIA test (Mikrogen Diagnostik, Germany). The immunoblot assay RecomLine HEV IgG/IgM (Mikrogen Diagnostik, Germany) was used for confirmation. RESULTS: Using the RecomWell IgG EIA test, anti-HEV IgG reactivity was found in 115 (6.7%) of 1715 sera. No significant difference in the anti-HEV IgG reactivity was found between men 58 (6.9%) and women 57 (6.6%). The prevalence of anti-HEV IgG increased with age from 3.5% in the age group 15-24 years to 16.8% in 55-64-year-olds. CONCLUSIONS: The prevalence of hepatitis E IgG antibodies determined in the serological survey in the age group 15-64 years was 6.7%. Recalculated for the general population of the Czech Republic, the prevalence was 8.6%. The prevalence of anti-HEV antibodies increased with age, reaching a peak of 16.8% in the age group 55-64 years. The prevalence was not significantly different between men and women. Using the immunoblot RecomLine IgG test for the confirmation of the specificity of the screening test in the seroprevalence study was not of clear benefit.

The occurrence of Ixodes ricinus ticks and important tick-borne pathogens in areas with high tick-borne encephalitis prevalence in different altitudinal levels of the Czech Republic Part II. Ixodes ricinus ticks and genospecies of Borrelia burgdorferi sensu lato complex.

STUDY OBJECTIVE: Three years long research study (2011-2013) on population density of Ixodes ricinus and the infection rate of the pathogens that they transmit was conducted in four topographically distant areas in the Czech Republic. In the previous decade (2001-2010) thirteen loci with increased incidence of tick borne encephalitis cases were defined, suggesting the permanent interaction of human population with ticks and indicating the landmarks for study of the presence of other tick borne pathogens. The work program included the identification of existing spectrum of spirochetes from Borrelia burgdorferi sensu lato complex and the conditions of their occurrence and distribution. MATERIAL AND METHODS: In the areas of the Ústí nad Labem Region, Olomouc Region, South Bohemian Region, and Highlands Region, 600 m2 plots were selected in the local optimal I. ricinus habitats where tick flagging was performed every year in the spring-summer and autumn seasons of the tick questing activity. Collected adult ticks (1369 males and 1404 females) were individually screened for B. burgdorferi s. l. spirochets. RESULTS: Spirochetes from B. burgdorferi s.l. complex were detected in all 13 studies sites in all altitudes from 280 to 1030 meters a. s. l. The total rate of infection was determined as 11.4% (males 10.4%, females 12.4%) with range limits from 1.4% (Ústí nad Labem in 2011) to 19.7% (South Bohemian Region, 2012).Genospecies were detected in various proportions and in different combinations: Borrelia afzelii, B. garinii, B. burgdorferi s. s., B. bavariensis, B. bissettii, B. valaisiana, B. spielmanii and B. lusitaniae. The three-year observation justifies the assumption that the regional differences in infectivity of I. ricinus are based on the character of the local biocenosis of the respective region. The dynamics of its seasonal changes, conditioned by climatic factors, determines the annual differences. CONCLUSION: Three of the medically most important Borrelia species formed a core group among all detected genospecies. B. afzelii was a dominated one (115 detections), followed by B. garinii (100) and by B. burgdorferi s.s. (19). Other genospecies were detected sporadically. However, the detection of B. bissettii should be emphasized due to the recently proven pathogenic effects of this genospecies and yet little-known sporadic expansion in the Czech Republic. The medical importance and distribution of other sporadically occurred genospecies is also discussed.Key words: Ixodes ricinus - Borrelia afzelii - B. garinii - B. burgdorferi s. s. - B. bavariensis - B. valaisiana - B. spielmanii - B. lusitaniae - B. bissettii - distribution - altitude - season - medical importance.

The occurrence of Ixodes ricinus ticks and important tick-borne pathogens in areas with high tick-borne encephalitis prevalence in different altitudinal levels of the Czech Republic Part I. Ixodes ricinus ticks and tick-borne encephalitis virus.

STUDY OBJECTIVE: The aim of the three-year study (2011-2013) was to monitor population density of Ixodes ricinus ticks and its infection rate with the tick-borne encephalitis virus in areas with a high incidence of tick-borne encephalitis as reported in the previous decade 2001-2010. Such a comprehensive and long-term study based on existing epidemiolo-gical findings has not previously been conducted in Europe. MATERIAL AND METHODS: In the areas of the Ústí nad Labem Region, Olomouc Region, South Bohemian Region, and Highlands Region, 600 m2 plots were selected in the local optimal I. ricinus habitats where tick flagging was performed every year in the spring-summer and autumn seasons of the questing activity. In total, 18,721 I. ricinus ticks (1448 females, 1425 males, and 15,848 nymphs) were collected and investigated. RESULTS AND CONCLUSION: The results have shown that the differences in the infection rate of I. ricinus observed between regions are driven by variation in the density of the local I. ricinus populations which is influenced by the characteris-tics of the whole local biocenosis. The overall prevalence estimate of TBE virus in Ixodes ricinus ticks at the altitudes below 600 m a.s.l. was 0.096 % (95% CI 0.055-0.156) for nymphs, and 0.477 % (95% CI 0.272-0.773) for adults. The dynamics of the seasonal variation in I. ricinus populations, depending primarily on the climatic factors, are behind the interyear differences in the infection rate of ticks and, consequently, in the epidemiological situation of tick-borne encephalitis. The nymph to adult ratio was 5.5 on average but showed great interregional variability (from 10.3 in the Ústí nad Labem Region to 1.8 in the Highlands Region). It might be used in the future as one of the indicators of the composition of the local I. ricinus population and of the level of the circulation of tick-borne pathogens in zoonotic sphere and also for use in the health risk assessment in a given area. Despite the permanent expansion of ticks and tick-borne pathogens in higher altitudes the high risk limit for human infection with tick-borne encephalitis is 600 m a.s.l. in the Czech Republic.

[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.

Seroprevalence study of hepatitis E virus infection in two districts of the Czech Republic.

The aim of this work was to retrospectively examine serum samples from 230 people living in two districts in the Czech Republic in year 1989 (Znojmo and Jihlava) for the IgG antibodies against hepatitis E virus (HEV). For examination, commercial ELISA kit DIA.PRO was used and 13 seropositive persons were found, i.e. 5.7% of those examined. The seropositivity rate was higher in women (6.8%) than in men (3.7%), but the difference was not statistically significant. The age of examined persons did not reveal a significant effect on the seropositivity rate: mean age of seropositive subjects was 38.0 years while that of seronegative persons was 39.4 years.

Seroepidemiology of mumps in Europe (1996-2008): why do outbreaks occur in highly vaccinated populations?

Mumps outbreaks have recently been recorded in a number of highly vaccinated populations. We related seroprevalence, epidemiological and vaccination data from 18 European countries participating in The European Sero-Epidemiology Network (ESEN) to their risk of mumps outbreaks in order to inform vaccination strategies. Samples from national population serum banks were collected, tested for mumps IgG antibodies and standardized for international comparisons. A comparative analysis between countries was undertaken using age-specific mumps seroprevalence data and information on reported mumps incidence, vaccine strains, vaccination programmes and vaccine coverage 5-12 years after sera collection. Mean geometric mumps antibody titres were lower in mumps outbreak countries [odds ratio (OR) 0·09, 95% confidence interval (CI) 0·01-0·71)]. MMR1 vaccine coverage ⩾95% remained protective in a multivariable model (P < 0·001), as did an interval of 4-8 years between doses (OR 0·08, 95% CI 0·01-0·85). Preventing outbreaks and controlling mumps probably requires several elements, including high-coverage vaccination programmes with MMR vaccine with 4-8 years between doses.

Comparative seroepidemiology of diphtheria in six European countries and Israel.

Serological surveys for diphtheria were conducted in six European countries including Czech Republic, Hungary, Ireland, Latvia, Luxembourg, Slovakia and one country outside Europe, Israel. For each country, a nationally representative population sample was collected across the entire age range and was tested for antibodies to diphtheria toxin. Although each national laboratory used its preferred assay, the results were all standardized to those of the in vitro neutralization test and expressed in international units (IU) which allowed comparative analyses to be performed. The results showed that increasing age is related to a gradual increase in seronegative subjects (<0·01 IU/ml of diphtheria antitoxin antibodies). This may reflect waning immunity following childhood vaccination without repeated booster vaccinations in adults. Differences in seronegativity were also found according to gender. In subjects aged 1-19 years, geometric mean titres of antitoxin are clearly related to the different vaccination schedules used in the participating countries. Although clinical disease remains rare, the susceptibility to diphtheria observed in these serosurveys highlights the importance of strengthened surveillance.

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.

Seroprevalence of hantavirus antibodies among chronic hemodialysis patients in the Czech Republic.

A total of 348 serum samples were collected from 301 hemodialysis patients with chronic renal failure of four healthcare settings in Western Bohemia. The sera were screened for the presence of hantavirus antibodies using ELISA kits (PROGEN Biotechnik GmbH) with Hantaan and Puumala antigens. Specific anti-Puumala antibodies were detected in five patients (1.7%). Although hantaviruses are known to cause primarily acute renal damage (interstitial nephritis) in Eurasia, chronic effects of hantavirus infection and the detection of specific antibodies in hemodialysis patients have also been reported. Nonetheless, the detection of seropositivity is not proof of an etiological link between hantaviruses and chronic renal failure. The hantavirus seropositivity rate in hemodialysis patients was not significantly higher than that in the general population. Our findings are consistent with the literature data and do not contradict the contribution of hantaviruses to the pathogenesis of chronic renal damage in the Czech Republic.

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.

A comparison of hepatitis B seroepidemiology in ten European countries.

To inform current and future vaccination strategies, we describe the seroepidemiology of hepatitis B virus (HBV) infection in ten representative European countries using standardized serology that allowed international comparisons. Between 1996 and 2003, national serum banks were compiled by collecting residual sera or by community sampling; sera were then tested by each country using its preferred enzyme immunoassays and testing algorithm, and assay results were standardized. Information on current and past HBV vaccination programmes in each country was also collected. Of the ten countries, six reported low levels (<3%) of antibodies against HBV core antigen (anti-HBc). Of the eight countries testing for HBV surface antigen (HBsAg), the highest prevalence was reported in Romania (5.6%) and in the remaining seven countries prevalence was <1%. Universal HBV vaccination programmes had been established in seven countries as recommended by the World Health Organization, but the seroprevalence of antibodies against HBsAg (anti-HBs) was lower than the reported vaccine coverage in three countries. Regular serological surveys to ascertain HBV status within a population, such as reported here, provide important data to assess the need for and to evaluate universal HBV vaccination programmes.

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.

Correlation between meteorological factors and tick-borne encephalitis incidence in the Czech Republic.

The objective was to discover whether there any demonstrable relationships exist between the incidence of human tick-borne encephalitis (TBE) cases and current meteorological factors and to specify their character. Epidemiological data were extracted from the EPIDAT database (National Institute of Public Health, Prague). Analyzed were a total of 4,613 TBE cases registered in the whole Czech Republic (1994-2001) and 4,637 cases registered in the territory of Bohemia (1994-2004). Meteorological data were from the database of the Czech Hydrometeorological Institute in Prague. A linear relationship has been found between TBE incidence and temperature factors in all the years under study. Lagged cross correlation was used (with the lags in time respective to incubation period from infected tick attack to initial TBE symptoms) and close relations were found for daily mean air temperature and lags 6-14 days (with a peak of 9 days). Effects of the current course of the meteorological situation (as well as long-term year-to-year changes) on TBE incidence are, foremost, mediated by the influence of climatic factors on Ixodes ricinus ticks and their host-seeking activity; under certain conditions, also by the effects of momentary weather on human behavior as TBE in the Czech Republic is a recreational disease connected with outdoor activities.

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).

Phenotypic and genotypic analysis of Borrelia spp. isolated from Ixodes ricinus ticks by using electrophoretic chips and real-time polymerase chain reaction.

The genotype of Borrelia burgdorferi sensu lato was detected in 371 out of 1244 ticks. Borrelia determination was based on partial sequencing of the 16S rRNA gene and real-time polymerase chain reactions for identification and quantitation of ospA and recA genes. Different Borrelia spp. were identified; B. garinii in 40% ticks followed by B. afzelii (36.3%), B. burgdorferi sensu stricto (12.9%), B. valaisiana (3.5%), B. lusitaniae (0.8%), B. bissettii (0.5%) and B. miyamotoi-like (0.5%). Cultivation of 30 borrelia strains in BSK-H medium, among them B. valaisiana, B. bissettii-like and B. miyamotoi-like strains was unique in Czechia. Calibrated microfluidic-based quantification showed differences in the concentration of the nucleic acids and molar mass of the outer surface proteins of different Borrelia spp. with standard sensitivity and specificity and was helpful for their identification. The outer surface protein OspA was absent in B. miyamotoi-like and the OspB protein in B. valaisiana, B. lusitaniae and in three subtypes of B. garinii.