Surveillance in Poland: BINet experience. Anna Skoczyńska National Reference Centre for Bacterial Meningitis

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Ewa Elżbieta Czech
8 lat temu
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1 Surveillance in Poland: BINet experience Anna Skoczyńska National Reference Centre for Bacterial Meningitis

2 Poland ~ 38 mln 2007 introduction of vaccination against Hib No mass vaccination against pneumococci (only risk groups)

3 Polish surveillance system for invasive bacterial infections 1997 establishment of the National Reference Centre for Bacterial Meningitis (NRCBM) Until 2005 only meningococcal and H. influenzae meningitis cases were reported Others were notified as other bacterial meningitis (incl. S. pneumoniae) Mandatory reporting of cases for all age groups Two notification systems Obligatory: based on MD reports (NIPH-National Institute of Hygiene) Voluntary: laboratory based (the NRCBM)

4 Beginning.. meningitis cases only N. meningitidis S. pneumoniae H. influenzae no of isolates

5 IMD associated with very high mortality in the North-West of Poland April April 2004: 21 IMD cases, total CFR = 42.9% all the fatal cases were diagnosed as fulminant meningococcal septicemia The situation in the studied area accelerated changes in the registration system currently there is a compulsory notification of all invasive cases

6 After changes in registration system N. meningitidis S. pneumoniae H. influenzae no of isolates

IMD outbreaks in Poland, 2006-2007 Skwierzyna III.2006 (4) Warszawa I.

7 IMD outbreaks in Poland, Skwierzyna III.2006 (4) Warszawa I.2007 (15) Brzeg II.2007 (7) Kluczbork 2007 (5) Bytom VI.2006 (3) MenC, ST-11

8 After IMD outbreaks no of isolates/pcr N. meningitidis S. pneumoniae H. influenzae

9 2008 project BINet was established to enhance laboratory based surveillance of community-acquired invasive bacterial infections in Poland N. meningitidis S. pneumoniae H. influenzae S. pyogenes S. agalactiae E. coli L. monocytogenes S. aureus* Coordination by the NRCBM Every lab can send isolates and also clinical material from IBI for non-culture diagnostic For laboratories involved in the project, shipment of isolates/materials and diagnostics is free of charge Currently ~ 180 hospital labs involved in the net Lębork Gdynia Gdańsk Elbląg Tczew Koszalin Malbork Kętrzyn Kościerzyna St.Gdański Suwałki Gryfice Biskupiec Olsztyn Goleniów Szczecin Grudziądz St.Szczec. Świecie Mława Toruń Białystok Trzcianka Bydgoszcz Łomża (6 ośr.) Ciechanów Maków Maz. Ostrów Maz. Inowrocław Pułtusk Gniezno Płock Wyszków Sokołów Podl. Poznań (6 ośr.) Słupca Wołomin Konin Kutno W-wa Zielona G. Środa Wlkp. Koło Skierniewice (16oś Mińsk Maz. Biała Podlaska Wolsztyn Kościan Zgierz Grodzisk Jarocin r.) Maz. Nowa Sól Leszno Kalisz Łódź Krotoszyn Łask Lubartów P.Tryb. Radom Puławy Opoczno Bełchatów Lublin Końskie Stąporków Legnica Wrocław Sk.-Kam. Ostrowiec Św. Krasnystaw Brzeg Starachow. Jelenia Góra Oława Kielce Sandomierz Świdnica Częstochowa Zamość Wałbrzych Opole Janów Lub. St.Wola Gliwice Sosnowiec Tarnobrzeg Biłgoraj Tomaszów Lub. Bytom Proszowice Tychy Mielec Kędzierzyn-Koźle Zabrze Ruda Śl. Przeworsk Rybnik Kraków (5 ośr.) Łańcut K-wice Oświęcim Tarnów Rzeszów Racibórz Dębica Jastrzębie Zdr. Brzesko Wadow. Myślenice Krosno Cieszyn Bielsko Żory Limanowa -Biała Jasło Przemyśl Gorlice Sucha B. Nowy Sącz Sanok Nowy Targ Zakopane

10 With BINet Number of isolates / PCR N. meningitidis S. pneumoniae H. influenzae 100 0

11 Activity of the NRCBM Year Isolates Materials for PCR Results (298) (376) (489) (468) (489) (596) (631) (641) (734) 1987

12 Remarks after years of surveillance More isolates and materials sent to the NRCBM More patient s data collected (NRCBM - phone calls) Transport free of charge Diagnostic free of charge But also Better contact with microbiologists and clinicians Education: meetings, lectures, newsletters, publications, consultations The NRCBM website with needed information

13 Problems with surveillance system Lack of regulations (law) Funding Long time only meningitis was notified (IPD meningitis ~ 30%) Rare blood sampling Prior antibiotic therapy (IPD ~ 30%) PCR more often used for suspected IMD Compulsory vs voluntary notification More and more data expected More and more detailed characteristics needed

14 Underestimation of IPD, Poland 2015 (n=700) 6,00 Incidence of IPD (n/100000) 5,00 4,00 3,00 2,00 1,00 0,00 4,08 2,75 0,84 0,17 0,10 0,24 0,67 2,36 4,83 1,82

15 Case fatality ratio from IPD by age groups, 2015 (infections with known outcome, n=517) Total <2 0,0 0,0 0,0 0,0 0,0 5,3 28,3 35,8 36,2 46,0 0,0 10,0 20,0 30,0 40,0 50,0 Case fatality ratio (%)

16 Serotypes distribution among IPD cases, 2015 (n=655) Number of isolates F 4 19F 19A 9N 6B 9V 7F 23F A 12F 11A 23B 6A 18C 23A 38 6C 15B/C 35F 15A 31 33F C 17A others* *11 serotypes represented by 1-2 isolates Serotype

17 Theoretical PCV vaccine coverage, 2015 Theoretical vaccine coverage (%) PCV10 PCV13 82,1 75,0 67,9 64,8 53,6 38,0 < 2 (n=28) < 5 (n=56) Total (n=656)

18 Conclusions Outbreaks help, unfortunately Education Feedback Improvement with permanent problems, although long way to go (underestimation)

19 Acknowledgments We thank all BINet participants and all other physicians and microbiologists who participated in the national surveillance programme of invasive infections in Poland, contributing isolates and data. Part of the study was supported by the programme Modul I NPOA of the Ministry of Health; Project MIKROBANK 2 of the Ministry of Science and Higher Education and unrestricted grant from Pfizer. Team of the NRCBM: Waleria Hryniewicz Alicja Kuch Izabela Waśko Agnieszka Gołębiewska Patrycja Ronkiewicz Marlena Kiedrowska Izabela Wróbel Anna Skoczyńska

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