Search

In the first half of 1993 an increased incidence of invasive meningococcal disease was recorded in the Czech Republic. In the CR a total of 59 cases were revealed, incl. 10 fatal ones. This high lethality (16.9%) is markedly higher than that from 036 recorded in this country during previous years. The highest incidence and death rate was recorded in the North Moravian region and in the age group from 15-19 years. Based on active surveillance of the invasive meningococcal disease by epidemiologists, microbiologists and infectiologists of the entire Czech Republic, it may be concluded that the sulphonamide sensitive strain Neisseria meningitidis C:2a:P1.2 caused in the North Moravian region a local epidemic of invasive meningococcal disease in the army and civilian population. In other regions of the CR the epidemiological situation in the first half of 1993 did not differ from the previous period: sporadic incidence of meningococcal disease, prevalence of the serological group B, highest incidence in the youngest age groups. The meningococcus C:2a:P1.2 was not detected in the CR before 1993. This uncommon epidemiological situation was resolved by immunization, aimed from the antigenic aspect and with regard to age and locality.

During 1990 and partly also 1991, after a practically 10-year zero incidence of measles on the territory of the Czech Republic a measles epidemic broke out. The most severely affected group were adolescents aged 15-19 years who were immunized only by a single dose of vaccine. Conversely the lowest morbidity was recorded in 2-9-year-old children who were immunized already with two doses. The cause of the epidemic was primary failure of the vaccine leading to a low level of collective immunity in some population age brackets. The authors discuss and explain the strategy of immunization against measles involving two doses of vaccine after a 6-10-month interval. In the conclusion possibilities to achieve permanent elimination of measles on our territory are discussed.

In a group of 38 patients with the Guillain-Barré syndrome (SGB) and a group of 38 patients selected at random who suffered from meningoencephalitis the authors compared the characteristics by age, sex, onset of the disease (month of the year) and intervals between the onset of the disease and collection of serum samples. Using the neutralization microtest, the sera were examined for antibodies against 23 serotypes of enteroviruses incl. polioviruses. The groups differed significantly in the following indicators: the SGP group had a non-seasonal annual distribution, it included different age groups, there were longer intervals of sample collection. There were fewer cases with an assessed enteroviral aetiology, no case with a polioviral aetiology. More detailed analysis of serological results revealed, that the group does not differ fundamentally as regards the immunological experience of individuals with enteroviruses before the disease. The authors discuss the need of more detailed examinations of the enteroviral aetiology in all cases of SGB.

The authors analyze the epidemic incidence of alimentary infections of bacterial origin in two periods: 1979-1983 and 1984-1988 and 1989 resp., where in each period the number of notified epidemics of different infections equals 100%. During the period 1984-1988 as compared with 1979-1983, there was a decline in the number of epidemics of salmonelloses in health institutions from 42% to 14%, whereby almost half these epidemics were caused by Salmonella agona spread via dried milk. Conversely there was an increase in the number of epidemics of salmonelloses in communities from 14% to 23% and in works canteens from 9% to 14%. In 68% of the latter Salmonella enteritidis dominated. In 1989 there was a potent increase epidemics of salmonelloses. In 86% of the notified epidemics Salmonella enteritidis was the aetiological agent. A quarter of these epidemics developed in works canteens and half the affected subjects were ill. The transmission occurred via poultry meat and egg products. The annual incidence of bacillary dysentery after 1985 has a declining trend, the epidemics persist in nursery schools, summer camps for children and are increasing in institutes for social care. The number of alimentary intoxications is rising in recent years, in particular in school and works canteens. The number of 008 epidemics in 1984-1988 declined in health institutions from 52% to 20%. 17% of the epidemics developed in schools and camps for children.

The authors give an account of the development of the definition and context of epidemiological surveillance during the past decades in Czechoslovakia and in the world. They analyze views of epidemiologists who contributed in a major way to the modern concept of surveillance. The concept of surveillance reflects social conditions in the widest sense of the word and its contents are and probably will also in future be the subject of lively discussions. The authors assume that in the near future a more important part will be played by an active approach to surveillance of infections, as no modern system of health care can do without its development. Contemporary social changes will play a decisive role.

At present epidemiological informations are dispatched from epidemiological departments of regional hygiene stations in different forms to different departments. The separate follow up of partial information leads to the development of different isolated information systems. Individual information systems help to resolve information problems in epidemiology, they provide, however, only limited opportunities when causal relations are sought and applied in the control of diseases. Surveillance calls for a uniform information system which concentrates scattered information in a single epidemiological centre. The author formulates possible approaches to the solution of the information problem in epidemiology.

On the example of existing information systems of communicable diseases the authors analyze the possibilities of and draw attention to the obstacles of their wider use. The following information systems are involved: ARO (acute respiratory diseases), APO (acute diarrhoeal diseases), ISBT (information system of bacillary tuberculosis), ISPO (information system of communicable diseases), ISID (information system of child immunization). In the general evaluation the authors draw attention to the demand to do away with the scattered character of the system and the necessity of delimitation of the responsibility for the establishment and operation of the information systems. The authors indicate the future desirable development.