National Immunization Policy in the Czech...
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1 National Immunization Policy in the Czech Republic 13.-14.2.2008 Roman Prymula
Transcript of National Immunization Policy in the Czech...
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National ImmunizationPolicy in the Czech Republic
13.-14.2.2008
Roman Prymula
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Country Background
Demographics: Population 10,3 milionObligatory health insurance (9 funds)Combined capitation in primary careMostly privat primary careSecondary care – state, municipal, private Primary paediatric care– 2200 medical practices– 900 children per practice – children 0-19 years
Immunization Calendar Czech Republic – since 1.1.2007
THBIPVD-T-aPM-M-RD-T-aP-Hib-HB-IPVBCG
Y14-15Y14
Y12-13Y12
Y11-12 Y11
Y10-11Y10
Y5-6Y5
Y2
M21-28M15-18M13-18Y1
W21-24W17-20W13-16D4-W6Y0
M12M11M10M9M8M7M6M5M4M3M2M1
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Vaccine recommendations
– Governmental responsibility– Chief Public Health Officer
• Boards of experts – Preventable diseases Board– Advisory Board of Chief Public Health officer for
epidemiology– Vaccinological society
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Obligatory vaccine coverage
Level (%) of vaccine coverage for the diseases included in calendar/schedule
• BCG 98.5 %• DTP 97.0 – 98.7 %• Polio 96.7 %• Hib 97.0 %• MMR 96.7 %• HepB 87.2 % (birth)
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Measels – Czech Republic
17
0
72
30
46
9 9
2
19
1410
50
5
10
15
20
25
30
35
19941995199619971998199920002001200220032004200520062007
Year
No
of R
epor
ted
Cas
es
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Rubella – Czech Republic
4883128
3156
894
1876743974
6820
852
2842
7640
10002000
30004000
5000
60007000
8000
19941995199619971998199920002001200220032004200520062007
Year
No
of R
epor
ted
Cas
es
8
1234
5172
1803
244
7537481071678 120117410
882
57595821
0
1000
2000
3000
4000
5000
6000
7000
19941995199619971998199920002001200220032004200520062007
Year
No
of R
epor
ted
Cas
es
MumpsMumps –– CzechCzech RepublicRepublic
Source: EPIDAT 2008
9
4388252487
35217
35197357193347435343
45299
38665
37170
50907
4560841025
48344
0
10000
20000
30000
40000
50000
60000
19941995199619971998199920002001200220032004200520062007
Year
No
of R
epor
ted
Cas
esChickenpoxChickenpox –– CzechCzech RepublicRepublic
Source: EPIDAT 2008
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Influenza - SurveillanceCurrent Monitoring of ARI - started in 1968 as a part of a comprehensive programme of prevention and control. (Thisprogramme followed the influenza morbidity monitoring which had started in 1951 at the reference laboratory of the Czechoslovak influenza headquarters, one of the first laboratories in the WHO network.) Weekly reports of ARI by participating GPs and GPPs to NIPH (via district and regional level (50 – 55% of theCzech population.
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Influenza - recommendations
Risk groups – persons with chronic diseases(respiratory disorders, cardial diseases, chronic renal diseases, diabetes, cysticfibrosis, immunological (both primary andsecondary), and hematological disorders)People 65+ not included in previous item,Health care workers, People from critical infrastructure, People in higher risk of transmission
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Flu - Free Immunization
Immunization against Flu• Long-term care facilities, Rest homes,
Social care facilities (based on Directive of Ministry of Health No. 537/2006 Sb.) Reimbursement Directive of Ministry of Health No. 63/2007 Sb (of Health Insurance with co-payment– patients 65+ with co-morbidities
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Cervical Cancer (CR vs. Europe) Incidence per 100 000 females
27,3025,20
23,9021,30
18,70
10,80
4,30
0,00 5,00 10,00 15,00 20,00 25,00 30,00
Serbia and MontenegroAlbania
RomaniaBosnia Herzegovina
Czech RepublicSlovakia
PolandHungaryUkrainePortugal
Russian FederationGermany
FranceUnited Kingdom
ItalySpain
Finland
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05
1015202530
74 76 78 80 82 84 86 88 90 92 94 96 98 0 2 4
Incidence Death Rate
Incidence 23,1 24,1 22,4 22 21,7 20,2 20,3 20 21,3 21,9 21,9 21,6 22,7 22,2 21,6 20,7 20,7 21,1 23,2 22,2 22,9 21,6 20,8 19,3 20 21,1 19,8 19,9 20,3 19,2 19,7Death Rate 8,4 8,5 8,3 8,6 8,4 7,8 8,1 7,8 7,8 9,6 8,5 9,9 9,6 9,7 9,9 9,5 7,8 9 8,6 9 8,1 8,4 7,8 7,76 7,7 7,42 6,9 7,4 7,6 7,5 7,4
74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 0 1 2 3 4
Incidence/100 000
Roky
Sourcej: ÚZIS ČR
HPV HPV -- CaCxCaCx –– CzechCzech RepublicRepublic
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Current Ca Cx screening program
1966 – Czech National Health Law
Every woman in Czech Republic can have complex gynecological examination oncea year (colposcopy, cytology - PAP smear and gynecology examination)….
......screeningscreening systemsystem worksworks in in theorytheory
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screening interval – annually - no age adjusted differentiationsstart – after the first intercourseend – no limit
primary screen test – PAP smearsensitivity: 60% screening is passive (occasional)- low coverage of population
Low quality of conventional cytology without quality control- more small labs with heterogenousprocedures
Current Ca Cx screening program
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Mass immunization of girls 12-13 years (economic constrains), recommended for women until 26
Various Advisory Boards – various recommendations
Who will be covered by national healthcare insurance? Insurance fund allowance 1000 CzK(10-12%)
Recommendation for HPV
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Conclusion
Excellent coverage in obligatory vaccinationsRecommended vaccinations are perceived as not so important– Coverage: TBE 16%,
Flu 6-7%, PCV7 20% (in children less than 2 years)
