Przeglad epidemiologiczny最新文献

Background: Hepatitis B remains a serious public health problem worldwide. Achievement of the goals of the global hepatitis elimination strategy has been significantly delayed, especially during the COVID-19 pandemic. Since 2022, a gradual levelling of hepatitis B epidemiological indicators has been observed in Poland.

Objective: The aim of the study was to assess the epidemiological situation of hepatitis B and hepatitis B vaccination coverage in Poland in 2023 and 2024, compared to previous years.

Material and methods: The epidemiological situation of hepatitis B was assessed based on the analysis of the national hepatitis B and HBV infections surveillance system data recorded by the local sanitary and epidemiological stations in the Epibaza system. Data published in the annual bulletins "Infectious Diseases and Poisonings in Poland" and "Vaccinations in Poland" were also used, as well as data on deaths provided by the Demographic Surveys Department of Statistics Poland (GUS).

Results: In 2023 and 2024, 36 and 32 cases of acute hepatitis B were recorded, respectively, resulting in an incidence of 0.1/100,000 and 0.09/100,000. The share of migrants among acute hepatitis B patients was 39% in 2023 and 25% in 2024, with no cases among children or young adults. Acute hepatitis B cases occurred in 14 of 16 voivodeships in 2023, and in 13 of 16 voivodeships in 2024. In 2023, 3,106 chronic and unknown stage (CHB and UNK) cases were recorded, and in 2024, 3,513, with a diagnosis rate of 8.24/100,000 and 9.35/100,000, respectively, which were higher than in the previous years. Imported cases of CHB and UNK accounted for 7% in 2023 and 9.9% in 2024, mostly acquired in Ukraine. The most frequently identified probable route of infection was medical procedures. Hepatitis B vaccination coverage HepB3 among 1-year-olds (in their second year of life) was 89.5% in 2023 and 87.3% in 2024.

Conclusions: In 2023 and 2024, a further increase in the number of diagnosed hepatitis B cases was observed, to levels exceeding those observed before the COVID-19 pandemic. Reintroduction of testing and the increased number of migrants, particularly from Ukraine, contributed to the increase in the incidence and the diagnosis rate of HepB cases. In 2023 and 2024, further declines in hepatitis B vaccination coverage among 1-year-old children were recorded, to below 90%.

Background: In 2023, a significant increase in the number of pertussis cases was recorded in Poland, which is consistent with the trend of a resurgence of respiratory diseases observed across Europe following the COVID-19 pandemic. This increase is related to factors such as declining population immunity, delays in vaccinations, and diagnostic difficulties, particularly in adults and adolescents.

Objective: The aim of the study was to assess the epidemiological situation of pertussis in Poland in 2023 compared to the situation in previous years, with particular emphasis on assessing the impact of the COVID-19 pandemic and assessing the vaccination status of children against pertussis.

Material and methods: The assessment of the epidemiological situation of pertussis in Poland was made based on the results of the analysis of individual reports on pertussis cases registered at the National Institute of Public Health NIH - National Research Institute in the EpiBaza system and data from the annual bulletins "Infectious diseases and poisonings in Poland" and the bulletin "Vaccinations in Poland in 2023".

Results: In 2023, 922 cases of pertussis were recorded. The incidence was 2.45/100,000, which was 150% higher than in 2022. The highest incidence of pertussis occurred in children aged 0-4 years (17.3/100,000), and high in children aged 5-9 years (7.6/100,000). Approximately 45% of cases occurred in people over 15 years of age.

Conclusions: In 2023, the number of pertussis cases in Poland increased more than 2.5-fold compared to the previous year, which is due, among other things, to the complete lifting of pandemic restrictions and an increase in social contacts. Pertussis remains a significant public health threat, and waning post-vaccination immunity promotes transmission, especially among adolescents and adults, who can infect infants.

Background: In 2023, according to the World Health Organization (WHO), 10.8 million people worldwide developed tuberculosis. Tuberculosis remains a public health problem in the countries of the EU/EEA.

Objective: To analyze the epidemiological situation of tuberculosis in Poland in 2023 by comparing it with the situation in EU and EEA countries.

Material and methods: Analysis of cases registered in the National Tuberculosis Register in 2023 and drug susceptibility testing results; data from Statistics Poland on deaths due to tuberculosis in 2023; data from the NIZP PZH - PIB on tuberculosis cases as an AIDS-defining condition; and the ECDC report on tuberculosis in EU/EEA countries in 2023.

Results: In 2023, 4,436 cases of tuberculosis were registered in Poland. Pulmonary tuberculosis was diagnosed in 4,265 individuals (96.1% of all cases), 11.3 per 100,000 population. Extrapulmonary tuberculosis accounted for 171 cases (3.9% of all cases). Bacteriological confirmation was obtained in 3,460 cases of pulmonary tuberculosis (81.1%), with a notification rate of 9.2 per 100,000. Cases of foreign origin accounted for 7.9%. MDR-TB was diagnosed in 99 patients (3.1% of cases with drug susceptibility results); three individuals had isolated rifampicin resistance. Tuberculosis notification rates increased with age. In 2023, 51 cases of tuberculosis were reported among children aged under 14 years and 62 cases among adolescents aged 15-19 years, corresponding to rates of 0.9 and 3.3 per 100,000, respectively. The notification rate among men was three times higher than among women. Foreign nationals accounted for 7.9% of cases. Tuberculosis was the cause of death in 483 individuals.

Conclusions: In 2023, tuberculosis notification rates in Poland were 3.5% higher than in 2022. The proportion of MDR-TB cases was lower than in EU/EEA countries. The proportion of children aged under 14 years among all tuberculosis patients in Poland was 1.1%, compared with 4.5% in EU/EEA countries. Tuberculosis mortality in Poland has not decreased.

Atherosclerosis is a chronic, progressive process affecting medium and large arteries, while peripheral artery disease (PAD) represents one of its clinical manifestations in the limb arteries. Although classical risk factors such as poor diet, hypertension, diabetes, and smoking are well established, increasing evidence indicates that the gut microbiome is an important and modifiable contributor to vascular pathophysiology. This paper reviews current knowledge on the role of the gut microbiome in the initiation and progression of atherosclerosis and PAD, with emphasis on bacterial metabolites, proinflammatory mechanisms, and potential therapeutic interventions. Gut dysbiosis-an imbalance in the intestinal microbial community-has been associated with increased cardiovascular risk. Patients with vascular diseases show higher levels of pro-atherogenic taxa, including Enterobacteriaceae, Streptococcus spp., Lachnoclostridium, and Family XI, alongside a reduction of beneficial short-chain fatty acid (SCFA)-producing bacteria such as Roseburia, Faecalibacterium, Coprococcus2, and Ruminococcaceae. Two key microbial metabolites influence vascular health. Trimethylamine N-oxide (TMAO), formed from choline and L-carnitine via microbial and hepatic metabolism, promotes endothelial dysfunction, inflammation, and platelet reactivity, thereby accelerating atherosclerosis. Conversely, SCFAs-acetate, propionate, and butyrate-exert anti-inflammatory effects, improve insulin sensitivity, and enhance nitric oxide synthesis, resulting in vascular protection. Therapeutic strategies targeting the gut microbiota show promising potential. These include the use of probiotics and prebiotics (notably Lactobacillus rhamnosus GG), adherence to a Mediterranean diet, and fecal microbiota transplantation (FMT), all aimed at restoring eubiosis and a favorable intestinal metabolic profile. In summary, the gut microbiome appears to be a key modulator of the pathogenesis of atherosclerosis and PAD. Targeted modulation of gut microbial composition and activity may emerge as an innovative and effective strategy for the prevention and treatment of cardiovascular diseases.

The acronym TORCH designates a group of pathogens that can lead to serious pregnancy complications, such as miscarriage, fetal growth restriction, and congenital infections. This review summarizes current insights into these infections, offering practical guidance primarily for obstetricians, infectious disease specialists, and general practitioners involved in prenatal care. The TORCH complex includes Toxoplasma gondii, Rubella virus, Cytomegalovirus (CMV), and Herpes simplex virus (HSV). The definition may be extended to encompass additional (other) pathogens such as Hepatitis B and C viruses (HBV, HCV), Human immunodeficiency virus (HIV), Varicella-zoster virus (VZV), Treponema pallidum (syphilis), Parvovirus B19, and Zika virus. Screening practices for TORCH infections during pregnancy vary significantly across countries. Despite widespread access to medical care and increasing awareness among women planning pregnancy, routine screening for TORCH pathogens is not universally implemented. In Poland, diagnostic procedures during pregnancy are defined by the Standard of Perinatal Care established by the Ministry of Health. This regulation- which replaced earlier recommendations of the Polish Society of Gynecologists and Obstetricians- does not distinguish between ,,mandatory" and ,,recommended" tests but specifies a unified set of investigations to be performed at defined stages of pregnancy. Screening conducted during pregnancy plays a crucial role in detecting previously unrecognized infections. In Poland , a substantial proportion of new diagnoses of HIV, HBV and HCV among young women are made during routine antenatal testing, underscoring the importance of standardized serological screening in prenatal care rather than relying on diagnosis before conception. However, due to their distinct epidemiological and clinical profiles, HIV, HBV, and HCV infections are not discussed in detail in this review.

Background: Food and waterborne diseases are a significant Public Health problem. In recent years, their epidemiology has been influenced by the COVID-19 pandemic and the increasing burden of Clostridioides difficile infections (CDI).

Objective: Assessment of epidemiological situation of foodborne infections and intoxications in Poland in 2021-2023.

Material and methods: Routine surveillance data collected by the District Sanitary and Epidemiological Stations (PSSE) through the Registry of Epidemic Outbreaks and data from the bulletins "Infectious Diseases and Poisonings in Poland" (2021-2023) were analyzed. Incidence, etiology, outbreak settings and hospitalization rates were assessed.

Results: In 2021-2023, an increase in the number of cases of bacterial infections and intoxications was registered (over 90,000 cases, incidence 80.2/100,000) related to an increase in Clostridioides difficile infections (56.4/100,000 in 2023 vs. median 29.5/100,000 in 2015-2019). Also, there was an increase in listeriosis incidence. Among viral infections most prevalent were rotaviral infections, with an increase in 2022 and a decrease in 2023 and incidence between 15.7-20.1/100,000. Between 2021 and 2023, 2,722 foodborne outbreaks were reported, in which 20,102 cases occurred (compared to 2,767 outbreaks and 22,681 cases between 2017 and 2019). Majority of outbreaks were of bacterial etiology (53%), among which the most prevalent were salmonellosis outbreaks, and in this category 80% were S. Enteritidis outbreaks. Proportion of Clostridioides difficile outbreaks was 21.5% (16.5% of all outbreak cases), in medical facilities, outbreaks of this aetiology accounted for 78% of outbreaks. Overall, 27.9% of outbreak cases were hospitalized, most frequently in CDI and hepatitis A outbreaks. Outbreaks occurred mainly in household settings; however, most cases occurred in food-serving facilities and medical facilities.

Conclusions: In 2021-2023, the number of foodborne infections and intoxications outbreaks was comparable with the pre-pandemic period, but its aetiology-related structure changed (increases in CDI and viral etiology outbreaks. Those results may confirm the need of ongoing surveillance enhancement and laboratory diagnostic capacity development.

Background: Mumps is a viral disease primarily transmitted by infected individuals. A milestone in controlling mumps in Poland was the introduction of mandatory MMR vaccination in 2003, protecting against measles, mumps, and rubella. Since then, the incidence has decreased substantially, and complications have become rare.

Objective: The aim of the study was to conduct an epidemiological assessment of the incidence of mumps in Poland in 2023 compared to previous years, taking into account the impact of the COVID-19 pandemic.

Material and methods: The analysis of the epidemiological situation of swine fever in Poland in 2023 was conducted based on the interpretation of data from the nationwide epidemiological surveillance system. The percentage of those vaccinated with the first dose was determined based on data for the 2021 cohort (children aged 3 years), and the percentage of those vaccinated with two doses was determined based on data for the 2017 cohort (children aged 6 years). Vaccination effectiveness was estimated using the screening method.

Results: In 2023, 966 cases of swine fever were registered in Poland. This represented a 4.8% increase in the number of cases compared to 2022, when 922 cases were reported. The overall incidence rate was 2.6 per 100,000 inhabitants, which was 5.3% higher than in 2022. The highest incidence rate, 3.6 per 100,000 inhabitants, was recorded in the Śląskie voivodeship, and the lowest, as in previous years, of 1.2 per 100,000 inhabitants in Dolnośląskie voivodeship. The highest incidence(13.7/100,000) was recorded in children aged 0-4 and 5-9 (17.3/100,000). The incidence in men (3.0/100,000) was higher than in women (2.1/100,000). In 2023, the number of hospitalisations due to mumps in Poland was 12, a decrease of 40% compared to 2022, when 20 people were hospitalized.

Conclusions: In 2023, there was an increase in the number of registered cases of mumps, indicating a general upward trend. The decline in cases in2020-2021was the result of the COVID-19 pandemic, which was accompanied by restrictions significantly limiting the transmission of diseases spread by droplets, including mumps. Despite the increase in the number of cases in 2023, the level remains below that observed in the period before the COVID-19 pandemic.

Adverse drug reactions (ADRs) remain a major, yet largely preventable, global public health challenge, causing significant morbidity, mortality, and healthcare costs. This review synthesises evidence on the global burden, pharmacovigilance systems, and prevention strategies for ADRs, integrating data from multiple regions, healthcare settings, and drug classes. Epidemiological findings reveal wide variability in incidence and mortality, with older adults, low-resource settings, and exposure to high-risk medicines-such as antibiotics, antiretrovirals, and cardiovascular agents-representing key vulnerabilities. Despite advances in surveillance, underreporting, data quality issues, and methodological biases persist, particularly in low- and middle-income countries. Comparative analyses of pharmacovigilance platforms, including World Health Organization's (WHO's) VigiBase, EudraVigilance, and EU-ADR, highlight complementary strengths and the value of integrating spontaneous reporting with electronic health record analytics. Emerging statistical methods, including machine learning and federated analytics, offer improved signal detection timeliness and precision. Prevention strategies span prescriber-level, system-level, and patient engagement interventions. These include clinical decision support systems, pharmacogenomic-guided therapy, deprescribing protocols, mobile reporting applications, and wearable biosensors. Evidence shows that active surveillance and automated alerts outperform voluntary reporting, while digital tools can enhance detection and risk communication. However, implementation remains uneven due to infrastructure, workforce, and policy gaps. Looking forward, achieving the World Health Organization's goal of halving severe medication-related harm by 2030 will require embedding ADR surveillance and prevention into universal health coverage frameworks. Policy priorities include mandating interoperable safety systems, harmonising international safety indicators, investing in capacity building for resource-limited settings, and aligning incentives with safer prescribing. Coordinated global action can bridge surveillance gaps, strengthen prevention, and build resilient, equitable pharmacovigilance systems, advancing both patient safety and sustainable health systems worldwide.

Background: Cardiovascular disease (CVD) complicates pregnancies worldwide and remains a major contributor to maternal mortality, particularly in low- and middle-income countries (LMICs).

Objective: This study aimed to evaluate the prevalence, clinical profiles, and outcomes of heart disease (HD) among pregnant women referred to the Joint Clinic of Pregnancy and Heart Disease at Al-Zahra Hospital and assess the utility and limitations of the modified World Health Organization (mWHO) risk classification system.

Material and methods: We analyzed a retrospective cohort of 389 pregnant women with confirmed heart disease managed at the Joint Clinic of Pregnancy and Heart Disease, a tertiary referral center, Al-Zahra Hospital (Isfahan, Iran), between March 2017 and March 2023. Participants were followed until hospital discharge after delivery or pregnancy termination. Patients were stratified into mWHO risk classes and categorized by disease type, including congenital heart disease (CHD), valvular heart disease (VHD), cardiomyopathy, and other conditions. Clinical outcomes, including maternal mortality, abortion and delivery methods were examined.

Results: VHD was the most prevalent condition (35.99%), followed by CHD (20.82%). Severe mitral stenosis and prosthetic heart valves were the most common VHD subtypes. Among CHD cases, atrial septal defect was predominant. Class IV mWHO patients comprised 21.85%, highlighting the high-risk population. Cesarean deliveries were common (53%). Maternal mortality was 1.0%, with four deaths mostly due to pulmonary hypertension.

Conclusions: The observed outcomes in this high-risk cohort compare favorably to those reported in similar LMIC settings, suggesting that structured multidisciplinary care and mWHO-based risk assessment may contribute to improved maternal and fetal management. However, overlapping and unclassified conditions highlight the need to refine current risk stratification frameworks for pregnancy in cardiac patients.

Advanced HIV infection leads to profound immunosuppression and increased susceptibility to opportunistic infections. Resumption of antiretroviral therapy (ART) may result in immune reconstitution inflammatory syndrome (IRIS), which manifests as a worsening of an existing infection or the emergence of new ones. Disseminated mycobacteriosis caused by Mycobacterium avium complex (MAC) is one of the most severe opportunistic infections in the course of AIDS. The aim of this paper is to present the diagnostic and therapeutic difficulties in a AIDS patient who developed IRIS with generalized MAC infection and numerous metabolic and infectious complications following the resumption of ART, ultimately leading to treatment failure. We describe the case of a 34-year-old HIV-positive patient who had discontinued ART for several years. Clinical, laboratory, imaging, and psychiatric data collected during several months of hospitalization were analyzed. A multidisciplinary approach was employed, including antiretroviral, antimycobacterial, antifungal, nutritional, and psychiatric treatment. After ART was resumed, the patient developed IRIS in the form of disseminated MAC infection, confirmed in sputum, blood, and bone marrow. He developed refeeding syndrome, multidrug-resistant sepsis, and fungal and bacterial infections. Despite improved immunological parameters (increased CD4 and decreased HIV viral load), treatment was ineffective due to the patient's lack of compliance and worsening cachexia. This case illustrates the complexity of caring for patients with advanced AIDS and IRIS. Effective treatment requires a multidisciplinary approach, early diagnosis of IRIS, and consideration of psychosocial factors that can significantly complicate treatment and prognosis. .