Czech Republic: Diphtheria and Pertussis
Diphtheria
The National Institute of Public Health (SZU) has reported a death due to diphtheria in an 82-year-old man from Prague.
This is the first death due the disease reported in the Czech Republic since 1969.
"The patient from Prague, who was fighting an infection in the Jihlava hospital, most likely had a neck form of infection caused by the bacterium Corynebacterium diphtheriae. The patient did not suffer from any other serious illness, he was an athlete and an actively living senior citizen. Therefore, diphtheria was probably the direct cause of death," said Kateřina Fabiánová, deputy head of the Department of Epidemiology of Infectious Diseases of the SZÚ.
The definitive diagnosis of diphtheria will be confirmed by the National Reference Laboratory of the State Health Institute based on the results of examination of samples from the patient. Considering the clinical symptoms of the disease, which were completely typical and fatal for diphtheria in the patient, we assume that it was indeed a case of diphtheria.
Diphtheria disease reappeared in the Czech Republic in 2022 after 27 years when no such infection was recorded (From 1995 to 2021, not a single case of this deadly disease appeared in the country).
For the entirety of 2022 and 2023, a total of 12 cases were recorded.
From the beginning of 2024 to March 6, six patients fell ill with diphtheria, and now the first recorded death since 1969 has occurred.
"The development once again points to the importance of revaccination against diphtheria in adulthood”, said the director of the State Health Institute Dr. Barbora Macková, MHA. She added that revaccination against diphtheria is not yet recommended in the Czech Republic, although a proposal for revaccination of the Czech adult population was submitted by the Expert Working Group of the National Immunization Commission (NIKO) already in the spring of 2022. The proposal recommends revaccination against diphtheria at least at the age of 25 years and 40 years, possibly as part of regular revaccination against tetanus.
"The results of an international seroprevalence study in 18 European countries in persons aged 40-49 and 50-59 years showed a significant lack of antibodies against diphtheria in the adult population. In most of the evaluated countries, this is the result of a drop in post-vaccination immunity, which was also proven by the latest serological reviews in the Czech Republic," epidemiologist Kateřina Fabiánová also points out the importance of revaccination in adulthood.
In the Czech Republic, children are vaccinated against diphtheria compulsorily, and they receive the last dose of the vaccine between the ages of 10 and 11.
A diphtheria infection can be treated in the Czech Republic with commonly available antibiotics, but the condition requires timely diagnosis. It most often manifests itself as a severe sore throat with gray patches, or with attacked parts of the mucous membrane of the neck, which then lead to a narrowing of the airways and suffocation of the patient.
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Diphtheria is most often manifested as severe angina leading to narrowing of the larynx and pharynx and suffocation. Other symptoms include weakness, sore throat, fever, enlarged tonsils and difficulty breathing. Bacterial toxins can enter the bloodstream and damage the heart, kidneys, and central nervous system. Because of this, this disease is quite deadly.
In the Czech Republic, at the time of the last epidemic, i.e. during the Second World War, the mortality rate was between five and eight percent. Currently, diphtheria is most often found in poor African countries, where, according to the World Health Organization, the mortality rate is between 5-10 percent, with up to 20 percent in children under 5 years of age and in people over 40 years of age.
The basic protection against diphtheria is the vaccine. "Vaccination is the only effective method of preventing toxin-mediated disease," states the SZÚ. We started with this in 1946. That it worked well is shown by the numbers of sick people: after vaccination, the number of sick people began to decrease rapidly and practically disappeared in the 1970s - then only isolated cases appeared, often from people who became infected abroad.
Pertussis
The Czech Republic is also battling another vaccine-preventable disease—pertussis, or whooping cough.
From January 1 to March 3, 2024, 1,666 cases of pertussis were reported to health officials.
36 cases of pertussis were already reported in children under one year of age. The most cases of disease and the highest morbidity are in the age group of 15-19 years with nearly 500 cases.
The regions with the highest number of pertussis cases in 2024: South Bohemia (357) and Central Bohemia (258), followed by Vysočina (253) and Pardubický (216), the fewest cases are reported by Plzeňský (18) and Karlovy Vary (5).
The deputy head of the Department of Epidemiology of Infectious Diseases of the SZÚ, MUDr. Kateřina Fabiánová, Ph.D stated: It can be assumed that some people do not even go to the doctor with whooping cough and thus do not get into the statistics. The number of infected people can be even higher than what we see in the report.