Search

Aim: The aim of study was to evaluate completeness and estimate sensitivity of the measles surveillance using the new electronic version of the national notification system of infectious diseases (ISIN) in order to assess its performance., Material and Methods: The completeness of measles reporting in the ISIN for demographic characteristics (week and region of reporting, age and gender), date of onset, complications, hospitalisations, vaccination status, used laboratory methods and country of import from January 2018 to June 2019 was assessed. The register from National Reference Laboratory (NRL) and the ISIN were compared using the capture-recapture method (CRM). Cases were matched using unique personal identifier. The total number of measles cases in the population was assessed using the Chapmans formula. Sensitivity of reporting was calculated by dividing the number of reported cases by the CRM estimated true number of cases., Results: In the ISIN, 765 measles cases were registered within specified time period. For many variables 100% completeness was found. The data were missing mainly for vaccination status (20%), serology results (55%) and used laboratory methods (8%). The NRL confirmed 653 patient samples in respected period. Within both registries (ISIN and NRL) the total 612 cases were matched. Estimated real number of measles cases using the CRM was 816 (95% CI: 809-823) compared to 806 reported cases. The estimated surveillance system sensitivity was 98.8%. Five percent (n = 41) of cases tested positively in the NRL were not reported to the ISIN., Conclusions: We found high level of reported measles data completeness in the ISIN for most variables. Estimated real and reported number of cases was in a good correlation and calculated sensitivity of the ISIN was on very high level. Though, the data sources used in the study were not independent on each other, therefore results may not be fully accurate. The technical changes (more mandatory fields and more logical syntax to check data) in the ISIN to improve data completeness are being recommended. Data providers should report all measles cases to the ISIN with maximum precision in entering individual variables and investigating laboratories should send samples for confirmation to the NRL in required cases.

Salmonellosis and campylobacteriosis are the most frequently reported acute enteric diseases of infectious origin in the Czech Republic. Epidemiological data on salmonellosis and campylobacteriosis have been reportable in this country since 1951 and 1984, respectively. In 2003, 53,486 cases of acute enteric infections were reported: 26,899 (52%) diagnosed as salmonellosis and 20,063 (almost 40%) diagnosed as campylobacteriosis. In 1989, the annual incidence of salmonellosis was three times as high as in the previous year, the upward trend continued until 1995 (528/100,000) and since 1998 the salmonellosis incidence rates have been declining. The incidence of campylobacteriosis showed a progressive increase since 1984 to peak in 2002 with a following slight decline in 2003. Morbidity from salmonellosis and campylobacteriosis is highest in the age group 0-4-year-olds. The most frequent causative agents are Salmonella Enteritidis (96%) and Campylobacter jejuni, respectively. Both infections are foodborne. Ready-to-eat meals, poultry, confectionery and eggs seem to be most frequently implicated in outbreaks of salmonellosis in public catering and families. Sporadic cases of campylobacteriosis are mostly associated with ingestion of poultry and chopped meat. The incidence rates of these two infections are positively correlated with the average daily temperatures.

In recent decades an increase in the number of fractures of the proximal femur was recorded in this country and world-wide. The majority of patients with this diagnosis is above 70 years of age and their treatment comprises in addition to the medical aspect also economic and social problems. The objective of the present work is to summarize briefly the results achieved during the five-year trial focused on socio-economic problems of treatment of patients with fractures of the proximal femur. The investigated group comprised 244 patients hospitalized at the Orthopaedic Department of the Third Faculty of Medicine Charles University in 1997 with 248 fractures of the proximal femur. Thirty-nine fractures were treated conservatively, 116 by internal fixation and in 93 cases an arthroplasty was implanted. In the course of the first year of treatment 85 patients died. The therapeutic results after one year were evaluated in 159 patients. The total annual costs of the investigated group were 15.9 million crowns. The mean annual costs of treatment of one fracture of the proximal femur was 64,000 crowns. The ratio of deaths rose with age (p = 0.003), it did not depend on the social background of the patient (p = 0.16) and the quality of locomotor activity before the injury (p = 0.16). No type of fracture was associated with a higher or lower mortality (p = 0.09). A statistically significant higher mortality was recorded in patients included in the higher class of the ASA score (p < 0.001) and in conservatively treated patients (p < 0.001). The type of anaesthesia did not affect the mortality. The functional results were significantly worse in patients living before the injury in a dependent position (0.01 < p < 0.05) and with restricted physical activity (p < 0.01). The type of fractures did not affect significantly the functional results (p > 0.05). Poorer functional results were recorded in patients with ischaemic heart disease (p < 0.001) and neurological disease in their history (p < 0.001). Also inclusion into a higher class of surgical risk according to the ASA score was associated with poorer functional results (p < 0.001). Different types of anaesthesia and different methods of surgical treatment did not affect the quality of functional results. However the functional results were better in operated patients as compared with conservatively treated patients (p < 0.001).

Background: Multidrug-resistant (MDR) tuberculosis, defined as a disease caused by Mycobacterium tuberculosis strains, which are resistant to more antituberculous drugs (at least to isoniazid and rifampicin), is a problem frequently discussed in the Czech Republic. Cases of specific disease refractive to causal antituberculous therapy are associated with the risk of the spread of the causative agent among the population., Methods and Results: The National Reference Laboratory for Mycobacteria collected 2813 Mycobacterium tuberculosis strains isolated by Czech mycobacteriological laboratories in 1999 to 2001. All strains were tested for susceptibility to basic antituberculous drugs and then the MDR strains were further tested for susceptibility/resistance to other antituberculous and antibacterial drugs. The MDR strains were studied by DNA analysis (DNA fingerprinting restriction analysis, RFLP-Restriction Fragment Length Polymorphism) as well. Thirty-nine patients who had MDR tuberculosis were excretors of 56 Mycobacterium tuberculosis strains. In average, MDR tuberculosis accounted for 1.96% (1.7-2.4) of all cases of bacillary tuberculosis. The most frequent type of the multidrug resistance was that resistant to four basic antituberculous drugs (isoniazid, rifampicin, ethambutol and streptomycin). It was confirmed in 48.2% multidrug resistant strains., Conclusions: Isepamicin, clofazimin, capreomycin and amikacin are considered to be the most promising antituberculosis drugs. Based on RFLP profiles, 61.5% of strains were placed into 8 clusters while the other strains remained unclustered. No significant differences in geographical distribution and population structure were found between the excretors of clustered strains and those of unclustered strains. Preliminary comparison with restriction profiles of the MDR Mycobacterium tuberculosis strains in the international database suggests the uniqueness of Czech strains showing the profiles not found elsewhere to date.

In a pilot study Double Repetitive Element-Polymerase Chain Reaction 20 clinical isolates of Mycobacterium tuberculosis from Guatemala and 49 strains from Prague were typed. This technique is based on direct evidence of repetitive elements IS6110 or PGRS and does not require DNA purification, digestion by endonuclease nor Southern blot hybridization. Preliminary examination of Guatemalian strains revealed a striking identity or similarity of DRE-PCR profiles while the Prague strains were characterized by conspicuous polymorphism. The Prague strains were examined in a total number of 13 series of electrophoreograms and subsequently subjected to automated analysis with GelCompar software. The DRE-PCR method is suitable for screening of a major number of clinical isolates of M. tuberculosis in laboratories equipped with a minimum of technical facilities for the PCR method, furthermore it requires facilities for synthesis of the necessary primers and at least basic knowledge of molecular biology.

There are probably several causes why steady decrease of tuberculosis incidence stopped. The aim of our work was to investigate a possible relation of tuberculosis incidence in smaller administrative areas with several social and economic characteristics. The individual data were taken from the Information System of Bacillary Tuberculosis, based on laboratory reporting network. Tuberculosis incidence dropped to 19.8/100,000 in 1987 and since then it fluctuates around that level. The levels in districts ranged from 1.9 to 45.6 in 1997. The social status, overcrowding, air pollution and unemployment rates are weakly correlated with tuberculosis incidence. These unfavourable values of social, economical and ecological indicators are linked with more industrialised parts of the country. Age and gender analysis shows that male population aged from 40-60 is the most affected population with higher rates of smear positive pulmonary TB. These rates are positively linked with a size of the municipality, in larger towns higher number of those cases are detected. Contrary to that, relatively higher rates of pulmonary tuberculosis are in elderly women in smaller municipalities. There is a suspicion about important role of relative poverty in the epidemiology of tuberculosis in the Czech Republic. The results indicate that we should concentrate our effort to reduce the incidence of tuberculosis mainly in economically active male population.

The Central Europe forms a buffer zone between the countries of the European West reporting tuberculosis notification rates lower than 20 per 100,000, the cut-off set between low and high incidence areas, and the Eastern European countries including the republics of the former USSR, Russia and the Baltic States. The Czech Republic holds an intermediate place between these two territories with the total notification rate of tuberculosis cases 18.8, 9.7 bacteriologically verified and 5.7 positive in direct smear per 100,000 in 1996. Data on drug resistance obtained from the WHO/IUATLD Global Project on Anti-Tuberculosis Drug Resistance Surveillance were available from the Czech Republic, the only Central European country participating in the Project. The prevalence of resistant cases was here low: 2% primary and 13% acquired, and MDR cases were recorded in 1% of untreated and in 6% of repeatedly treated patients. The first microepidemic of MDR cases comprising 21 individuals was characterized by DNA fingerprinting. This outbreak pointed out the MDR tuberculosis as a new, extremely serious phenomenon in the epidemiology of tuberculosis. Corresponding data from Estonia and Latvia showed incomparably higher values in the drug resistance pattern: from 28 to 34% primary and 46 to 74% acquired resistance. MDR strains were reported in 9 to 14% of untreated and in 19 to 54% of repeatedly treated patients.

All livebirths resulting from singleton pregnancies reported to the Czech (n = 380,633) and Swedish (n = 351,775) birth registries in 1989-91 were studied with respect to social variation in birthweight, ponderal index (weight/length at birth3) and preterm delivery. The mean birthweight was significantly lower in the Czech population (3310 g vs. 3522 g, P < 0.001). The mean difference in birthweight between children of mothers with primary and university education was 197 g [95% CI 190, 205] in the Czech and 136 g [95% CI 128, 144] in the Swedish population, adjusted for maternal age, parity and sex of the infant. Mean birthweight was significantly higher in mothers who were married or lived with partners in both countries; the difference was 167 g [95% CI 161, 173] in the Czech Republic (CR) and 86 g [95% CI 78, 94] in Sweden, adjusted for age, parity and sex. The extent of social variation in ponderal index and frequency of preterm birth was also greater in the CR. Between 1989 and 1991, mean birthweight in the CR fell from 3323 g to 3292 g (P < 0.001) and the social differences increased, largely as a result of more rapid worsening in the lower socio-economic groups. There did not appear to be such a decline in birthweight in Sweden. We suggest that the fall in mean birthweight and the increasing social variation in birth outcome in the CR is related to decline and divergence in living standards in 1989-91.

The primary objective of the SAVIAH, a multi-centre study funded by European Union, was to assess new methodology for study of small area health statistics and to implement it in epidemiological health statistics and geography. In Prague, the study has been conducted in two city districts with large variation in air pollution. Data at individual level (health symptoms and socio-economic circumstances of the family) were collected by questionnaires completed by parents of 3680 children aged 7-10 both resident and attending schools within the area (response rate 88%). Aggregated data for geographical areas were available from census and urban planning sources for 692 enumeration districts in the study area which were aggregated into 75 medium sized areas. Outdoor concentrations of nitrogen dioxide (NO2) were monitored by passive samplers. All these data were integrated into a geographic information system (GIS). Spatial distribution of air pollution was estimated by kriging and multiple regression modelling. These models explained about 80% of the variation in air pollution measured by passive samplers. GIS was then used to assign to individuals an exposure based on place of residence and school in order to conduct individual based analyses. Association between NO2 and life-time prevalence of wheezing and/or whistling, and wheezing/whistling in the last 12 months was studied by logistic regression. For both outcomes, school levels of NO2 were positively related to symptoms but home levels of NO2 showed a negative association. Logistic regression at individual level gives similar results as ecological analysis and multilevel modelling. Hierarchical model yielded somewhat wider confidence limits. Adjustment for parental behavioural and socio-economic factors did not affect these estimates substantially. This study demonstrated the power of the GIS methodology in studying the effects of complex environmental factors on respiratory health of children.

Background: Socioeconomic factors have been identified as important determinants of morbidity and mortality in many populations but only few studies examined their importance in the Czech population. The objective of this study was to analyse the relationship between socioeconomic characteristics and mortality in districts of the Czech Republic in 1989-1993., Methods and Results: The association between age-standardised mortality (for men and women separately) from all causes, all cancers, lung cancer, cardiovascular and ischaemic heart disease in the age group 35-64 and socioeconomic characteristics of districts reported from the 1991 Census was studied in multiple linear regression. In principle, associations between socioeconomic factors and mortality were similar for all causes of death. Mortality was inversely related to percentage of population with secondary and university education and to proportion of population with any religious denomination. After controlling for other factors, correlation coefficients (r) between all cause mortality and proportion of population with primary education were 0.69 in men and 0.64 in women; for the proportion of population with any religious denomination the r were -0.42 and -0.72, respectively. Relation of mortality to mean of persons per room was stronger in women (r = 0.29) than in men (r = 0.10). Population density was most closely correlated with ischemic heart disease (r = 0.41) in men and 0.43 in women). Available socioeconomic factors explained over 60% of geographical variation in mortality from all causes, more than 50% of variation in cancers and about 40% of variation in ischaemic heart disease., Conclusions: Although ecological studies do not allow firm identification of causal factors, our results agree well with other studies, and confirm the important effect of socioeconomic factors on health in the Czech population.