Stefanoff Pawel, Zielicka-Hardy Anna, Hlebowicz Maria, Konior Ryszard, Lipowski Dariusz, Szenborn Leszek, Siennicka Joanna, Orlikova Hana
Parasit Vectors. 2013 Jun 18;6:180. doi: 10.1186/1756-3305-6-180.
Tick-borne encephalitis (TBE) is found in limited endemic foci in Poland. Lack of diagnosis limits disease detection in non-endemic provinces.
In 2009, we enhanced TBE surveillance to confirm the location of endemic foci and inform vaccination policy. In 105 hospitals located in 11/16 provinces, we identified suspected TBE cases through admission ICD-10 codes indicating aseptic meningo-encephalitis or from specimens tested for TBE. The National Reference Laboratory confirmed cases at no cost, by testing serum and/or cerebrospinal fluid using ELISA method. We calculated TBE reported rates as the number of confirmed TBE cases per 100,000 inhabitants. Adjusting to neighbouring districts, we classified districts as non-endemic (<0.1 cases per 100,000 inhabitants), low endemic (> = 0.1 to <1), moderately endemic (> = 1 to <5) and highly endemic (> = 5). We compared surveillance data obtained in 2009 with 2004-2008 baseline data.
Among 166,099 admissions, we identified 1,585 suspected TBE cases of which 256 were confirmed. Physicians reported more suspected cases among patients <40 years old (12 cases per 1,000 admissions) than among older patients (8 cases per 1,000 admissions). However, patients <40 years of age were confirmed less frequently (16%), than older patients (35%). Physicians reported more suspected cases in districts classed as endemic during 2004-2008 (12 cases per 1,000 admissions, 77% tested for TBE) than in districts classed as non-endemic (7 cases per 1,000 admissions, 59% tested). Of the 38 newly identified endemic districts, 31 were adjacent to 2004-2008 endemic districts and 7 were isolated.
Enhanced surveillance detected 38 new endemic districts to be considered for TBE vaccination. However, lack of consistent testing in districts believed to be TBE-free remained an obstacle for mapping TBE risk. Although the disease affects mostly older adults and the elderly, more attention is given to the diagnosis of TBE in young patients. Solutions need to be identified to sustain sensitive, acceptable and affordable TBE surveillance in all districts of Poland. Also, higher attention should be given to the diagnosis of TBE in the elderly.
蜱传脑炎（TBE）在波兰的有限地方性疫源地被发现。诊断的缺失限制了非地方性省份疾病的检测。
2009年，我们加强了TBE监测，以确定地方性疫源地的位置并为疫苗接种政策提供信息。在位于16个省份中11个省份的105家医院，我们通过表明无菌性脑膜脑炎的入院ICD - 10编码或从检测TBE的标本中识别疑似TBE病例。国家参考实验室通过使用ELISA方法检测血清和/或脑脊液免费确诊病例。我们将TBE报告率计算为每10万居民中确诊的TBE病例数。根据相邻地区进行调整后，我们将地区分为非地方性（每10万居民中<0.1例）、低地方性（>=0.1至<1）、中度地方性（>=1至<5）和高度地方性（>=5）。我们将2009年获得的监测数据与2004 - 2008年的基线数据进行了比较。
在166,099例入院病例中，我们识别出1,585例疑似TBE病例，其中256例得到确诊。医生报告的<40岁患者中的疑似病例（每1000例入院病例中有12例）多于老年患者（每1000例入院病例中有8例）。然而，<40岁的患者确诊频率（16%）低于老年患者（35%）。医生报告的2004 - 2008年被归类为地方性的地区中的疑似病例（每1000例入院病例中有12例，77%进行了TBE检测）多于被归类为非地方性的地区（每1000例入院病例中有7例，59%进行了检测）。在38个新确定的地方性地区中，31个与2004 - 2008年的地方性地区相邻，7个是孤立的。
加强监测发现了38个新的地方性地区，可考虑进行TBE疫苗接种。然而，在被认为无TBE的地区缺乏一致的检测仍然是绘制TBE风险地图的障碍。尽管该疾病主要影响成年人和老年人，但年轻患者中TBE的诊断受到更多关注。需要找到解决方案，以在波兰所有地区维持敏感、可接受且负担得起的TBE监测。此外，应更加关注老年人中TBE的诊断。
