The Czech Republic was formed in 1993, with the division of Czechoslovakia into two independent countries, the Czech Republic and Slovakia. Prior to this time, healthcare data were maintained in Czechoslovakia separately for the two federative states, the Czech and Slovak Republics. Identical geographic boundaries define the Czech Republic of the former Czechoslovakia and the current Czech Republic. Thus, data from 1982 to present are derived from the same population base.
The Czech Republic has 10 million persons, of whom approximately 200,000 (2%) are HCWs, similar to the proportion of HCWs in the United States (2.4%). Approximately 10,000 people enter the healthcare field annually. In addition, approximately 8,000 persons annually enter healthcare training, including medical, nursing, and other allied fields.
In 1983, vaccination of all “high-risk” HCWs became mandatory. High-risk HCWs included dialysis workers; internal medicine, surgery, and pathology specialists; biochemistry and hematology laboratory workers; medical and nursing students; and laboratory technicians. Vaccination schedules have varied according to availability of products and of national resources. From 1983 to 1989, the plasma vaccine H-B-VAX (Merck Sharp Dhome, Haarlem, The Netherlands) was used, with intradermal application of 0.1 mL at 0, 1, and 6 months. From 1990 to 1995, 0.5 mL of ENGERIX B (SmithKline Beecham, Rixensart, Belgium) was given intramuscularly at 0, 1, and 6 months. Beginning in 1996, the dose was doubled to the standard 1 mL/dose, given at the same interval and frequency. Vaccination was mandatory, and HCWs were not allowed to decline the series. A person is considered vaccinated only if a complete three-vaccine series has been administered. A booster dose at 5 years has been and will be given to all recipients of intradermal or half-dose vaccination.
Cases were identified as follows: all patients with diagnosed hepatitis of any etiology were hospitalized and isolated, and appropriate serologies were submitted (passive case finding) for reporting the result to the central hygiene station. Contact investigation was then undertaken (active case finding). The specific test varied according to the year of study. Currently, tests include hepatitis A antibody, hepatitis B surface and core antibody, hepatitis C antibody, and hepatitis B surface antigen.
Investigation of each case included serological testing of all family members and other contacts. All pregnant women were monitored for hepatitis B immune status, as were all HCWs, dialysis patients, and children of hepatitis B surface antigen-positive mothers. Among HCWs, hepatitis was considered an occupationally acquired compensable disease, increasing the likelihood of complete case-finding in this group. There is no perceived stigma and no restrictions for having hepatitis B. Hepatitis B patients are precluded from donating blood, but otherwise may resume their previous duties.
From 1982 to 1990, incident hepatitis B reporting was categorized as a “special compulsory” notification, meaning that highest priority was given to these reports. In 1991, hepatitis B reporting reverted to “routine notification.”
The countrywide annual rate of hepatitis B was derived from an established reporting system for numerous infectious diseases maintained at the National Center for the Analysis of Epidemiological Data of the National Institute of Public Health in Prague. The database included information for both the general population and for HCWs as a specific group within the general population. Information on the numbers of vaccinated HCWs was obtained from the staff of district and regional hygienic centers. Data were gathered from local treating physicians who performed the vaccinations.