Infectious diseases in Poland in 1999

Improvement of epidemiological situation of infectious diseases was continued in Poland in 1999. The end of epidemics of measles, pertussis, mumps, scarlatine, chickenpox, and rubella was observed. In comparison with the number of cases of infectious diseases registered in 1998, decrease in the number of notified cases of salmonellosis, dysentery, meningitis, encephalitis, and hepatitis type B and A as well as increase in the number of influenza cases and trichinosis was noticed. In 1999, compared with 1998, among all notified deaths percentage of deaths attributed to infectious diseases (0.80%) and infectious diseases death rate (7.71 per 100,000) were slightly higher as an effect of the influenza deaths increase.     

Infectious diseases in Poland in 1998

Epidemiological situation of majority of infectious diseases in Poland was in 1998 consecutively improved. Decrease of incidence of infectious hepatitis type A and B was noted as well as of tuberculosis and sexually transmitted diseases. Percentage of deaths caused by infectious diseases decreased to 0.6%. Sustaining of such positive trends will require first of all continuation of preventive immunizations at present level, improvement of laboratory diagnoses, but also an improvement of identification of diseased and infected peoples and also notification of cases.     

Infectious diseases in Poland in 2001

In 2001 surveillance system of infectious diseases in Poland remained unchanged. New cases of infectious diseases were recorded in 103 positions including intoxications. Tuberculosis and sexually transmitted infections were registered in separate systems. Influenza was the most frequently reported infectious disease with 576,449 cases, 63.9% less then in the previous year. The next most numerous were foodborne infections, which were reported in 24,393 cases, including 19,788 cases of infections caused by Salmonella sp. An increase in incidence was observed in the following diseases: viral hepatitis type A, rubella, measles and pertussis. Also the number of recorded cases of Lyme boreliosis and tickborne encephalitis were higher then in 2000. Incidence of AIDS remained within the range recorded during the last few years. In 2001 further drop in incidence of viral hepatitis type B was observed reaching the level of 6.2 per 100,000. It was the result of implemented comprehensive program of prophylactic measures, which brought incidence of this disease from the highest in Europe down to the level close to European average. Infectious diseases contributed to 0.75% of deaths. The most frequent cause of death among infectious diseases was tuberculosis and its sequels (1,061 cases). 13 cases of death due to tuberculosis occurred in people below 30 years of age.     

Infectious diseases in Poland in 2000

The decreasing tendency in incidence of infectious diseases observed in Poland in previous years as compared with 2000 has weakened or stopped. Increase in the incidence of selected infectious diseases can be linked with the improvement of surveillance resulting from the better diagnostics and greater attention paid to these diseases (including borreliosis, salmonella, and Haemophilus influenzae meningitis). Between 1999 and 2000, the most intense decrease in the number of mumps, measles, and scarlet fever cases as an effect of the end of epidemics was observed. At the same time increase in the number of pertussis, rubella, chickenpox, and meningitis cases was noticed. In 2000, the first case of human rabies since 1986 has been reported. In 2000, compared with 1999, among all notified deaths percentage of deaths attributed to infectious diseases (0.83%) and infectious diseases death rate (0.79 per 10,000) were slightly higher and were the highest in the last decade. As in 1999 the observed increase was effect of the influenza deaths increase (358 deaths, mortality 0.022%). The main disease causing the largest number of deaths, as in previous years, was tuberculosis (36.5% of total infectious diseases deaths).     

Infectious diseases in Poland in 2002

New regulations concerning infectious diseases effective in Poland since 2002 did not changed surveillance of infectious diseases. The most frequent infectious disease as in the previous years was influenza. 228.055 cases were reported (596.5/100,000). Number of foodborne infections and intoxications remains high--26.734 cases (69.0/100,000). 77% of them were caused by Salmonella. In this high number of foodborne infections in 4,492 (16.8%) etiologic factor was not found. In this number Campylobacter infections, rarely tested in Poland may be found. Especially alarming is number of cases of diarrhea among children 0-2. Age adjusted incidence of 2.464/100,000 is the highest occurrence among infectious diseases in Poland. There was noted decrease of incidence of newly diagnosed cases of viral hepatitis B (5.3/100,000) which dropped to the level of the incidence of viral hepatitis C (5.17/100,000). Hepatitis A remains at the low level (0.9/100,000). Level of newly diagnosed cases of AIDS (113 cases, 0.3/100,000) remains relatively stable for last few years. The major problem is decreasing reporting of possible risk factors. Infectious diseases caused 0.74% of deaths. Mortality from infectious diseases was 6.9/100,000 and was significantly higher among men (8.9) then among women. (5.1). In the age groups 35-64 it was 3-4 times higher. In urban settings mortality from infectious diseases was higher (7.2/100,000) then in the country (6.6). In particular districts (voivodeships) mortality indices remained in the range of 4.3 (opolskie) to 11.4 (?laskie). As in previous years, the highest number of deaths was caused by tuberculosis and its late sequels (35.4%). Attention should be given to the increased number of deaths due to sepsis (33.6%, without neonatal sepsis).     

Sexually transmitted diseases in Poland in 2003

In 2003 year 982 cases of all forms of syphilis were notified in Poland; incidence 2.57 per 100 000 population. The largest number of cases was in mazowieckie (257), dolno?laskie (124) and slaskie (131) voivodeships. The lowest was registered in kujawsko-pomorskie (13), opolskie (14) and swietokrzyskie (15) voivodeships. There were 446 recognized cases of early symptomatic syphilis and 13 cases of congenital syphilis. Latent syphilis (early and tarda) was diagnosed insufficiently due to decreased number of screening studies. In 2003 year there were 941 932 serum samples tested toward sexually transmitted diseases--it is 35% of the number of 1999 year. In 2003 year there were 670 cases of gonorrhoea notified; incidence 1.75 per 100 000 population. The lower number of venereal diseases notified in 2003 does not imply the actual smaller number of illness (cases). It suggests the less number of case reports. It is necessary to increase the budget assigned to diagnose and cost-free treatment of all venereal patients.     

Rabies in Poland in 2003

In Poland 399 cases of animal rabies were reported in 2003. Mass oral vaccination of wild animals against rabies, which was introduced in 1993, seems to show a positive impact on the epizootic situation of rabies in Poland. In 2003 we observed about three-fold decrease in number of animal rabies cases. The outbreak of animal rabies, which started in 2001 in Wielkopolskie voivodeship, was still present. About 42% of rabies cases were reported from this province. Moreover sources of wild and domestic animal rabies are present in the north-east, east, and south-east of the country. Out of 7 155 persons vaccinated in Poland against rabies, 519 (7%) were bitten by or had contact with a rabid animal. Main reason for vaccination against rabies was exposure to an animal category C--rabies not excluded (5 790 cases, 81%) or category D--animals healthy at the moment of an exposition (846 cases, 12%).     

Mumps in Poland in 2003

In 2003, 87,336 cases of mumps were reported in Poland. The incidence (228,7 per 100,000) was higher then in 2002(104.6), which corresponds to a periodical increase of mumps incidence. According to the natural periodicity the peak incidence would be expected to take place in 2002. The increase of mumps incidence in 2003, still lower however then the previous peaks, can be attributed to the prolongation of the epidemics cycle usually occurring with growing vaccine coverage. Even though the mumps vaccine was not included into the national immunization program, the coverage in 3-year old children in 2003 reached 39.6%. Approximately 4.6% of cases were hospitalized (4,056) and no mumps deaths were reported. Children 5-9 year old constituted the most affected age group (incidence 2,133.1 per 100,000). In Poland the MMR vaccine was recommended on voluntary basis in place of measles vaccine for children in their 2nd and 7th year of age. Immunization of 2-years old children is mandatory beginning in 2004.     

Botulism in Poland in 2003

A total number of 78 foodborne botulism cases were registered in Poland in 2003, (incidence rate 0.20 per 100 000 population), in rural areas--46 cases (incidence 0.31) and in urban areas--32 cases (incidence 0.14). There were noted 48 sporadic cases, 8 outbreaks of two persons and 1 outbreak of three, four and five people. Meat dishes were the main vehicle of botulinum toxin, especially home made bottling jars prepared from pork meat (24.4% of cases). Two deaths from foodborne botulism were registered.     

Salmonellosis in Poland in 2003

Total number of salmonellosis cases sharply decreased. In 2003, 16 617 cases were reported (20 688 in previous year), incidence rate = 43.5 per 100 000 population. 72.7% of patients were hospitalized, but percentage of hospitalized cases with extraintestinal manifestations was much higher--above 90%. The seasonal peak was observed as in previous years in July and August. The most frequent isolated type remained Salmonella Enteritidis--above 85% of cases. Only three other serotypes (Hadar, Typhimurium and Infantis) were detected in all of 16 voivodeships of Poland. The age, sex, urban/rural distribution of salmonellosis cases remains stable; the highest incidence was registered among children aged 2 (425.5/100 000). Extraintestinal manifestations of salmonellosis (septicemia, meningitis, pneumonia peritonitis and other) were observed in 121 patients (the highest number since 1994).     

Rubella in Poland in 2003

In Poland, 10,588 cases of rubella were registered in 2003 (incidence 27.7 per 100,000 population). No cases of congenital rubella syndrome were reported. A 74% decrease in incidence was noted, compared to 2002. Across voivodeships, the incidence ranged from 113.1 per 100,000 in warmińsko-mazurskie to 6.2 per 100,000 in lódzkie. As in 2002 rubella incidence among residents of urban areas was lower, compared to residents of rural areas (26.4 and 29.8, respectively). The incidence in men (32.3) was 38% higher than in women (23.4) and this difference appears to systematically increase with routine vaccination of 13-year old girls. The highest incidence was observed in children aged 7 (242.0 per 100,000) and 8 years (209.3). Approximately 0.5% of cases required hospital admission. No rubella deaths were registered.     

Tuberculosis in Poland in 2003

In 2003 year decrease of tuberculosis notification rates in Poland has continued. In this year 10 125 tuberculosis cases (TB) were notified in Poland--incidence rate--26.5 per 100 000 population, with the large differences in notification rates between voivodeships (from 16.9 to 39.8/100 000). Between 1994-2003 notification rates decreased by 3.9% yearly overall. 87.8% of the TB cases notified were new cases. Pulmonary cases represented 90.9% of TB cases. Male to female sex ratio--2.1. Age specific rates were much lower in children--1.5/100 000 (100 cases)--1% of all TB cases and highest in person over 65 years--57.6/100 000 (27.9% all TB cases). Sixty percent of all pulmonary cases were confirmed by culture and 38% were sputum smear positive. Among all the pulmonary TB cases treated there were 292 cases with resistance to at least one drug. They represented 3.4% of bacteriologically positive pulmonary cases treated and from many years remains relatively low. There 892 death due tuberculosis reported in 2002 y.i.e. 2.3/100 000. Mortality among males--3.7 and 1.1/100 000 among females. Since many years the TB mortality is of the order 0.2% of total mortality and almost 40% mortality from infectious diseases. In 2003 year--93.5% new born babies were vaccinated BCG; 82% of all TB pulmonary cases were detect by symptoms and 4% by contact examination. Success rates (cured or completed) of treatment were reported in 83.3%; failed 1.0%; deaths during treatment were reported in 6.2% (2.4% from TB) treatment default in 7.8% treated cases.     

Tetanus in Poland in 2003

In last decade gradual decrease in numbers of reported cases of tetanus was observed. In 2003, 30 cases of tetanus (14 women and 16 men) were reported in Poland. All those cases were among people of age 20 or more. In 2003 relatively high number of 14 deaths were recorded. All cases were unvaccinated or vaccination status was unknown. The data show effectiveness of vaccination program in younger age groups, but they also show need for promotion of post exposure prophylaxis, especially among older people both in rural and in urban areas. No case of neonatal tetanus was noted in Poland since 1984.     

Dysentery in Poland in 2003

The notified number of dysentery cases is the lowest in this century and even every year decreasing. Only 75 cases were notified in the year 2003 (incidence rate 0.20/100 000 population) while 220 cases were registered in 2002 (incidence 0.58/100 000 population). No one death case was notified. The last three death cases were notified in 1999. Only one outbreak of dysentery (due to S. flexneri 2a) was registered involving 23 patients/111 residents of Social Home for Mentally Disabled Men. Source of infection was probably one of residents who were infected during an outbreak of dysentery in the same institution four years earlier in 1999. The outbreak changed the overall etiology of dysentery cases in 2003: 52% was due to S. sonnei, but 46% was due to S. flexneri and 2% to S. dysenteriae 2, S. boydii were not found among persons examined bacteriologically by laboratory service of Epidemiological and Sanitary Service. The external quality control of procedures for selective investigation of Shigella infections in stool probe was done in 37 laboratories of Sanitary Epidemiological Stations with the use of control strain S. boydii 6. It was shown that in nearly all laboratories the strain was unable to grow on media SS and Hektoen after enrichment in the phosphate selenine--medium (SF) used by them. In the period of low frequency of Shigella infections the external control of the quality of bacteriological media and laboratory procedures is needed and should be done regularly.     

Malaria in Poland in 2003

Seventeen cases of malaria were reported in Poland in 2003. All of them were imported: 13 from Africa, 2 from Asia and 1 from Indonesia. In 8 cases P. falciparum etiology was confirmed. Among the cases 14 were men and 3 were women. The youngest patient was 10 and the oldest 63, 11 of the patients were in the age group 21 to 40 years. Most commonly the reasons for travel were tourism or family visits (6 cases), professional (4 cases) and missionary (4 cases) travel. One death from falciparum malaria was reported in Poland in 2003. In 4 cases some kind of chemoprophylaxis was documented. In other prophylaxis was not used or not documented.     

Measles in Poland in 2003

In Poland 48 measles cases were registered in 2003 (0.13 per 100,000 population)--of which 65% were cases imported from Chechnya and Afghanistan. Measles outbreaks occurred in 3 centers for immigrants. In total, 31 cases were reported, of which 96.8% were unvaccinated, and 93.5% were under 15 years of age. Of 17 local cases, 5 (29.4%) cases occurred in unvaccinated persons, 3 (17.6%) in persons vaccinated with one dose and 7 (41.2%) in those vaccinated with two doses of measles vaccine (administered at the age of 13-15 months and 7 years). Among 12 vaccinated cases only one 2-year old child was recently vaccinated. The remaining cases were in the 3-7 and 10-24 age ranges. The most affected were infants (incidence 0.57 per 100,000), 1-year old (0.28) and 2-year old children (incidence 0.27). Cases among adolescents and adults over 15 years of age increased from 23.5% in 2002 to 47.1% in 2003. The increasing age of locally-acquired cases, together with constantly high immunization coverage indicates high effectiveness of vaccinations in Poland. Out of all reported cases 13 (38%) were hospitalized. There were no deaths due to measles in Poland in 2003. Poland participates in the WHO Measles Elimination Strategy. Presently, the most important is the maintenance of a sensitive and timely surveillance of measles and measles-compatible cases, with serologic confirmation of one rash-like illness per 100 000 population. The performance of the surveillance system is insufficient with only 55 measles-compatible cases reported in 2003 (15% of expected reports). Serologic confirmation of cases was also insufficient, with 22 cases (40.0%) confirmed by IgM ELISA test. These results indicate the need to maintain the high immunisation coverage and improve measles surveillance system.     

Influenza in Poland in 2003

Following two years of low influenza incidence in Poland, the activity of this disease markedly increased in 2003. In total 1,216,285 cases of influenza like illness were registered (incidence 3,184.4 per 100,000). Regionally the incidence ranged from 1,195.7 in Zachodniopomorskie to 5,719.7 per 100,000 in Mazowieckie. Children and adolescents under 15 years of age accounted for 41.7% of all cases (507,102 cases, age specific incidence 7,579.0 per 100,000). In this age group the incidence varied regionally from 2,718.1 in Podlaskie to 14,087.6 per 100,000 in Mazowieckie. 3,128 patients (0.26% of all cases) required hospital admission. There were 141 deaths due to influenza (mortality 0.12%) in 2003, in 78.7% these were persons over 70 years of age. Nineteen strains of influenza virus were isolated in 2003 in Poland, including 15 strains of subtype A(H3), 3 strains of subtype A(H1) and one strain of type B. Besides, in other 10 cases influenza A infection was confirmed by direct immunofluorescence test. All isolated influenza strains were antigenically similar to the vaccine strains recommended for the epidemic season 2002/03 and 2003/04.     

Pertussis in Poland in 2003

Since reemergence of pertussis in Poland since 1997/1998 shift of incidence toward older groups of age was observed. Possible explanations include decreased effectiveness of used whole cell pertussis vaccine and lack of booster vaccinations in the age older than two. At least this last possibility was eliminated by introduction of additional dose of DTaP at the age of 6. Though effects of this change may be observed within several oncoming years. 2034 cases were reported in 2003, a slight increase from the previous year (1788 in 2002) More cases occurred among females (1159 cases, 5.9/100,000) than among males (875 cases, 4.7/100,000) and in urban areas (6.8/100,000) than in the rural ones (2.9/100,000). Big differences in numbers of cases reported between different districts and between urban and rural areas bring strong possibility of insufficient sensitivity of the surveillance in many regions of Poland.     

南宁市1994～2003年甲乙类传染病疫情动态分析

目的 了解南宁市法定报告传染病的流行及变化趋势,分析流行特点,为制定今后的防治措施提供科学依据。方法 对南宁市1994～2003年甲乙类传染病疫情年报表进行统计分析。结果 1994～2003年南宁市报告甲乙类传染病21种,共84330例,年平均发病率为298．39／10万,各年发病率有一定起伏,近几年有逐年上升的趋势。肠道传染病发病率仍处于较高水平;呼吸道传染病有明显上升的趋势,主要表现为肺结核发病率直线上升;血液及性传播疾病发病率一直居高不下,其病例数占传染病总数的43．21％,住居首位。结论 南宁市今后传染病防治工作重点不仅要加大对肠道和呼吸道传染病的控制力度,还要加强性传播疾病的宣传、教育、防治和监测工作。     

Hepatitis A in Poland in 2003

Epidemiological situation of hepatitis A in Poland since 1997 was evaluated as low endemicity and since 2002 as very low endemicity. High percentage of cases were noted among adult persons, especially in the age 25-29 years. The course of disease was more serious, than before 1997. In 2004 only 95 cases of hepatitis A were noted in Poland (Incidence rate 0.25/100 000). The number and percentage of unimmunized persons, especially among children, adolescents and young adults increases very rapidly. In such situation vaccination against hepatitis A of persons from risk groups is necessary.