WHO Surveillance Programme for Control Foodborne Infections and Intoxications in Europe Country Reports: Czech Republic BfR CZECH REPUBLIC Population 1999: 10 282 784 Population 2000: 10 272 503 Area: 127 869 km 2 1. General information 1.1 Organizational structure Under the Ministry Health the Czech Republic (country abbreviation: CZ), public health services at all levels (central governmental, regions and districts) are centralized. The Public Health Service is responsible for the collection and processing notifiable disease data. The National Institute Public Health in Prague carries the main responsibility for this activity and coordinates the reporting system notifiable diseases at the national level. Regional Institutes Hygiene and Epidemiology Control and District Institutes Hygiene and Epidemiology form a link between the top and basic levels Public Health Service. Data on the occurrence notifiable diseases is reported by the District Public Health Service to the Regional Public Health Service, which in turn forwards the information to the National Institute Public Health. Food inspection falls mainly under the responsibility the Veterinary Service the Ministry Agriculture and Food the Czech Republic, which cooperates closely with medical epidemiology and hygiene authorities.
Figure CZ 1 Structure and information flow the Public Health Service CZECH REPUBLIC MINISTRY OF HEALTH National Institute Public Health, Prague Regional Institute Hygiene and Epidemiologie 8 Regional Institutes Regional Institute Hygiene and Epidemiology District Institute Hygiene and Epidemiology District Institute Hygiene and Epidemilogy 85 District Institutes...... First contact reports to District Institute 1.2 Collection and processing data Data collection and processing is carried out with the EPIDAT program (based on the EPI- INFO system). EPIDAT was created by the Regional Public Health Service Central Bohemia to ensure the notification, registration and analysis morbidity due to infectious diseases. It extends the previous Information System Transmissible Diseases the Computer Technique Department the Regional Public Health Institute in Ostrava that had been in use between 1982 and 1992. Since 1993, EPIDAT has been used nation-wide by all public health services and currently is part the National Health Information System and forms the basis local, regional and national surveillance infectious diseases. Throughout the years, the program has been adapted to users needs and available equipment. EPIDAT is a health information system based on notification by attending physicians and those within the public health service. Inasmuch as it comprises personal data on patients and individuals at risk, it is governed by legislation on the protection personal data in health information systems. The system consists several interdependent sections allowing data entry at District level and data coding and transmission to the Regional level and to the National Institute Public Health, where major analyses for different periods are conducted. Data is entered continuously, data export is performed at one-week intervals, transmissions are executed by e-mail, and outputs are prepared weekly. The input and output files are referred to the National Institute Public Health, where access rights are dealt with. The transmitted data are encoded. 1.3 Coding and Definitions The obligatory notification communicable diseases, including foodborne infections and intoxications, is performed according to international recommendations and the ICD-10 coding system. At least two cases connected in any way or by any factor in place or time are - 2 -
considered an outbreak. Cases without any connection are considered sporadic. Cases in families (close collectives) are classified as family. 1.4 Information output A "Weekly Communicable Diseases Monitor" is released regularly. The "Monitor" is provided to all participating institutes hygiene and epidemiology and to the Ministry Health. It is available in printed or computerized form. A monthly and yearly analysis is regularly produced and provided to human and veterinary health authorities. 2. Statutory notification More than 60000 cases foodborne diseases were notified in 1999 and 2000 under the mandatory notification system. The most frequently notified disease was salmonellosis, comprising 74% all notified cases in 1999 and 63% cases in 2000, followed by campylobacteriosis, comprising 16% and 27% all cases for the years in question (Table CZ 1). An overview the number foodborne diseases notified between 1993 and 2000 is shown in Figure CZ 2. Table CZ 1 Notified cases foodborne diseases ICD- 10 Disease 1999 2000 Incidence rate Incidence rate notified cases notified cases A00 Cholera 0 0.00 0 0.00 A02 Salmonellosis 44845 436.12 40233 391.66 A03 Shigellosis 519 5.05 548 5.33 A04.4 E.coli enteritis 1212 11.79 1189 11.57 A04.5 Campylobacteriosis 9843 95.72 16916 164.67 A05 Other bacterial foodborne infections and intoxications 519 5.05 1091 10.62 A05.0 Staphylococcosis 16 0.16 24 0.23 A05.1 Botulism 5 0.05 2 0.02 A06 Amoebiasis 37 0.36 21 0.20 A07.1 Giardiasis 246 2.39 254 2.47 A08 Other viral enteritis 807 7.85 1197 11.65 A09 Infectious Enteritis unknown origin 1268 12.33 1323 12.88 A23 Brucellosis 0 0.00 0 0.00 A32 Listeriosis 13 0.13 23 0.22 B15 Hepatitis A 933 9.07 614 5.98 B67 Echinococcosis 1 0.01 1 0.01 B75 Trichinellosis 0 0.00 0 0.00 Total 60264 63436-3 -
Figure CZ 2 6000 5000 4000 3000 2000 1000 0 Notified Cases Foodborne Diseases CZECH REPUBLIC 1993-2000 salmonellosis cases 60000 50000 40000 30000 20000 10000 1993 1994 1995 1996 1997 1998 1999 2000 Year Shigellosis Hepatitis A Inf.enteritis unknown origin Other viral enteritis Giardiasis Amoebiasis Other bact. foodb. infect. Botulism E. coli * Salmonellosis * = 1993-1998 : EHEC cases; 1999-2000 : E.coli cases 0 2.1 Salmonellosis Table CZ 2 Notified salmonellosis cases by serotype Serotype 1999 2000 cases cases S.Enteritidis 42427 38355 S.Typhimurium 980 748 S.Infantis 160 273 S.Virchow 70 20 S.Hadar 54 21 S.Saintpaul 35 11 S.Agona 23 28 S.Montevideo 23 15 S.Derby 22 11 S.Newport 16 15 S.Heidelberg 13 7 S.Oranienburg 3 13 S.Paratyphi B var.java 12 4 S.Kentucky 10 5 Other serotypes 254 222 Total 44102 39748-4 -
A total 44102 and 39748 Salmonella isolates were serotyped in 1999 and 2000 respectively. In both years, S. Enteritidis was the most frequently identified serotype (96% cases). S. Typhimurium was isolated in 2% the cases (Table CZ 2). An overview the serotypes isolated between 1993 and 2000 is shown in Figure CZ 3. Figure CZ 3 4000 3000 2000 1000 0 Notified Salmonellosis Cases by Serotype CZECH REPUBLIC 1993-2000 1993 1994 1995 1996 1997 1998 1999 2000 Year S. enteritidis cases 60000 50000 40000 30000 20000 10000 0 S. Typhimurium S. Infantis S. Agona S. Tennessee S. Enteritidis 3. Epidemiologically investigated incidents Details were reported from investigations 121 foodborne disease involving 2775 cases in 1999 and 132 involving 5019 cases in 2000. The number persons ill, hospitalised, and dead, categorized by causative agent, is shown in Table CZ 3. The distribution foodborne disease cases according to age group is shown in Table CZ 4. Table CZ 3 Morbidity and mortality figures foodborne disease by causative agent Causative Agent persons ill persons hospitalized persons dead 1999 2000 1999 2000 1999 2000 Campylobacter sp. n.k. n.k. n.k. n.k. n.k. n.k. Campylobacter jejuni n.k. n.k. n.k. n.k. n.k. n.k. S. Enteritidis 2523 4539 286 551 1 6 S. Infantis 23 176 2 19 0 0 S. Typhimurium 213 138 38 5 0 0 Unknown 6 0 0 0 0 0 Total 2765 4853 326 575 1 6 n.k. = not known - 5 -
Table CZ 4 Age distribution cases foodborne diseases 1999 2000 persons ill aged 0 4 250 262 persons ill aged 5-14 635 1517 persons ill aged 15-59 1557 2426 persons ill aged 60 + 323 648 persons hospitalised aged 0-4 31 37 persons hospitalised aged 5-14 55 67 persons hospitalised aged 15-59 134 231 persons hospitalised aged 60 + 106 240 persons dead aged 0-4 0 0 persons dead aged 5-14 0 0 persons dead aged 15-59 1 0 persons dead aged 60 + 0 6 3.1 Causative agents The number and the number cases in by causative agent is shown in Table CZ 5. The most frequently identified agent was S. Enteritidis, followed by S. Typhimurium. The causative agent was identified both microbiologically and epidemiologically. Table CZ 5 Foodborne disease by causative agent Causative Agent 1999 2000 in in Campylobacter sp. 0 0 5 158 Campylobacter jejuni 1 10 0 0 S. Enteritidis 109 2523 121 4547 S. Infantis 1 23 3 176 S. Typhimurium 9 213 3 138 Unknown 1 6 0 0 Total 121 2775 132 5019-6 -
3.2 Incriminated food The number and the number cases in by incriminated food is shown in Table CZ 6. Eggs and sweets were the most frequently identified food items involved in foodborne disease in both 1999 and 2000. Thirty-three percent the cases in 1999 and 21% the cases in 2000 were linked to the consumption eggs, whereas sweets accounted for 26% the cases reported in 1999, and potato salad was responsible for 18% the cases investigated in 2000. Table CZ 6 Foodborne disease by incriminated food Incriminated food 1999 2000 in No. Of cases in Beef 1 13 1 31 Chicken 3 62 6 216 Curd pie 1 92 0 0 Delicacies 4 39 1 280 Dumplings 4 156 2 381 Dumplings, beef 0 0 1 13 Eggs 37 910 41 1036 Eggs, cheese 1 46 0 0 Eggs, chicken 0 0 1 28 Eggs, pork 0 0 1 15 Eggs, potato salad 1 30 0 0 Eggs, smoked meat 0 0 1 132 Eggs, sweets 1 14 1 12 Ice cream 1 39 0 0 Mayonnaise 2 11 2 16 Meat 3 89 0 0 Meat products 2 22 3 55 Milk products 1 69 1 81 Minced meat 0 0 2 55 Pastry 0 0 2 84 Pork 3 57 4 140 Potato salad 2 32 6 905 Poultry 1 5 6 338 Sauce 1 13 0 0 Smoked meat 0 0 1 54 Sweets 31 726 22 484 Vegetable products 1 8 0 0 Unknown 20 342 27 663 Total 121 2775 132 5019-7 -
3.3 Place consumption The number and the number cases in by place consumption is shown in Table CZ 7. In 1999, the place most frequently linked to foodborne disease investigated was the private home, followed by schools and canteens. In 2000, only 17% the investigated occurred in the private home, whereas 20% were linked to canteens and schools. While 24% the cases foodborne diseases were linked to the private home in 1999, 34% the foodborne disease cases reported in 2000 were linked to schools and 18% to canteens. Table CZ 7 Foodborne disease by place consumption Place consumption 1999 2000 in in Buffet 1 13 0 0 Camping 1 33 0 0 Canteen 12 353 26 901 Community 1 21 6 136 Educational establishment 2 96 3 342 Home for elderly people 5 123 7 298 Hotel 2 52 0 0 Kindergarten 7 182 16 361 Medical care facility 8 140 7 270 Nursery 4 50 0 0 Prison 0 0 2 43 Private home 39 654 23 408 Recreation establishment 5 99 4 103 Restaurant 8 117 5 206 Retail store 8 352 4 197 School 13 433 26 1721 Social care home 4 36 2 6 Other 1 21 0 0 Unknown 0 0 1 27 Total 121 2775 132 5019-8 -
4. Additional information Detailed information on foodborne disease reported between 1992 and 2002 can be found in the Monthly Report Infectious Diseases in Czech Republic, "Zpravy Cem", ISSN 1211 7358. A summary can be found on the web page http://www.szu.cz/cem/zpravy/default.htm. Additional information can be found on the web page the Centre Epidemiology and Microbiology (National Institute Public Health) at http://www.szu.cz/cema/hpcema.htm. For further reference on national and international data on foodborne diseases, please visit the web page http://www.euro.who.int/foodsafety/surveillance/20020904_1-9 -