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Epidemiology of multiple sclerosis
FOŠUM, Pavel
There are approximately 2.5 million cases of multiple sclerosis [MS] in the world. Each year, around 10,000 new cases of MS are diagnosed. There are approximately 0.1%. in the Czech Republic and that means that there are approximately 15,000 people with this disease. Multiple sclerosis is a progressive neurological inflammatory disease of the central nervous system in pathogenesis. The auto-immune mechanisms are appliedinvolves; both the affect the myelin and damaged axons. This damage is responsible for the permanent disability of MS. The main objective of this thesis was to use quantitative research to describe the occurrence of MS in the Regions of South Bohemia and Usti, and within objective to estimate the true prevalence of multiple sclerosis in the South and the Usti Regions. MUDr. Príkaszký and I used the method of descriptive epidemiological studies on the technique of data collection, as well as the analysis and the comparison of two sources using the double-capture method. As a research area, we used a set of patients with multiple sclerosis. The data were gathered in two regions of the Czech Republic: Usti nad Labem Region and South Bohemia. We investigated the number of patients from neurologists and MS centers in both regions.There is also the data on health insurance included with the Ústí Region in this research. According to the data, we estimated the prevalence of neurologists in South Bohemia to be 79.20 per 100,000 people. The MS Center at the hospital in Ceske Budejovice has registered 512 patients: 388 women and 124 men. The values of the MS Centre in Ceske Budejovice received from the neurologists are a total of 882 patients, which is a prevalence of 138.6 patients per 100,000 of the population. Regarding the Usti Region, the prevalence reported by neurologists is 208.2 per 100 000 people. The MS Center at the hospital in Teplice, has registered 1139 sick 730 women and 409 men. According to health insurance data in their database, of 1187 people listed with a diagnosis of G.35, 333 are men and 854 are women. This represents an estimate of the prevalence 305/100000 of the people who are registered in the NGA. We calculated the prevalence of illnesses from those sources in both of these regions is higher than the general estimates. When comparing the data source of health insurance and the model file from the MS center of Ústí Region, we calculated the overall sensitivity of 91.7% within a health insurance group. The calculation of the estimated prevalence has been reached by using the method of double-capture of those sources that provided an estimate of 2,681 patients in the Usti Region. The models of this data are mainly demonstrated as a possible approach to the estimate of the prevalence of this chronic disease in the case of multiple sclerosis. The information has been obtained from the collection of data. The results of this study can be used by other workers who have the same objective as this study.
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Epidemiology of tuberculosis - reaction on vaccine BCG
FOŠUM, Pavel
Epidemiology of tuberculosis-reaction to BCG vaccine World Health Organization records nine million people worldwide who fall ill with tuberculosis and more than three million who die of this disease a year. Tuberculosis has been known for a long time and despite the discovery of Mycobacterium tuberculosis etiological role by Robert Koch, the invention of RTG diagnostics by Roentgen and effective treatment using antibiotics by Waksman as the first, this disease still represents a considerable risk for society. Prevention using BCG vaccine has positive as well as negative aspects. This thesis is focused on describing newborn vaccination coverage, occurrence and duration of side and adverse effects after the application of BCG vaccine during the first days of life and on the influence on the following compulsory vaccination. We used the method of quantitative research in the form of epidemiology descriptive study using the technique of individual data collection and analysis. As a research area the group of children born in 2004, 2005, and 2006 was used. The group of 804 children (410 boys and 393 girls) was selected by the technique of random cluster sampling. We found out that out of 804 respondents 98.6 % were vaccinated with BCG vaccine. The group of 11 children was not vaccinated due to: HBsAg positivity of mother, low birth weight or health problems. Reaction after BCG vaccination was not healed until the next planed shot in 307 children (38.1 %). There were 4 people with no reaction at all to BCG (0.8%). The most frequent side (adverse) reaction after vaccination was scar unhealed at the time of next planed vaccination in 274 cases, (34.1%). Monoreactions accounted for more than a half of recorded reactions. Reaction time period was in the range from 11 to 300 days. Median of reaction time period was 30 days. We did not find any serious adverse reaction. Our research demonstrated, that frequency of side and adverse reactions after BCG vaccination is high (38.1 %). These are mainly benign side effects. We found that these reactions lead to postponing of the subsequent vaccination of the compulsory vaccination scheme in all who reacted to BCG vaccination. The occurrence of side reactions after BCG vaccine raises the question of appropriateness to carry out the BCG vaccination in first days of life. The results of this thesis can be used as a pilot study for the whole country study of mapping side and adverse reactions and further consideration of compulsory vaccination scheme.
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