A System Of Epidemiological Vigilance For Selected Infection

Original Language Title: o systému epidemiologické bdělosti pro vybrané infekce

Read the untranslated law here: https://portal.gov.cz/app/zakony/download?idBiblio=67660&nr=473~2F2008~20Sb.&ft=txt

473/2008 Coll.
DECREE


Dated December 17, 2008

System of epidemiological vigilance for selected infection

Change: 275/2010 Coll.

Change: 233/2011 Coll.

Ministry of Health, pursuant to § 108 paragraph. 1 of Law no.
258/2000 Coll., On protection of public health and amending some
related laws, as amended by Act no. 274/2003 Coll., Act No. .
320/2002 Coll., Act no. 274/2003 Coll., Act no. 392/2005 Coll., Act no. 222/2006 Coll
. and Act no. 110/2007 Coll., (hereinafter the "Act") to implement
§ 75a paragraph. 1 and 4 of the Act:

§ 1

This Decree regulates a range of infections for which there is a system
epidemiological vigilance (surveillance) and provides

A) the scope of the collected data about infections, method and time limits for reporting
,

B) laboratory diagnosis, epidemiological investigation and determination of the type and method of implementation
anti-epidemic measures of infectious disease

C) basic characteristics, clinical definition and classification
infectious diseases.

§ 2

Infections that are included in the system of epidemiological vigilance,
are listed in Annex no. 1 hereto.

§ 3

(1) The scope of the data and the procedure under § 1 point. a) to c) modifies the occurrence

A) diphtheria annex no. 2 hereto,

B) of pertussis Annex no. 3 hereto,

C) measles annex no. 4 hereto,

D) of influenza and acute respiratory infections annex no. 5 to this
decree

E) of invasive meningococcal disease annex no. 6 hereto,

F) of invasive disease caused by Haemophilus influenzae type b and b
non-Annex no. 7 to this Decree,

G) infections caused by the human immunodeficiency virus (HIV / AIDS) Annex.
8 hereto,

H) tuberculosis annex no. 9 hereto,

I) legionellosis Annex no. 10 hereto,

J), polio (poliomyelitis) Annex no. 11 to this
decree

K) tetanus annex no. 12 hereto,

L) of rubella and congenital rubella syndrome (CoP) Annex no. 13
hereto,

M) mumps Annex no. 14 hereto.

(2) The scope of the data and the procedure under § 1 point. a) to c) further adjusts at occurrence
:

A) West Nile Annex no. 15 hereto,

B) enterohemoragickými Escherichia coli (EHEC) Annex no. 16 to this
decree

C) of hepatitis A in Annex no. 17 hereto,

D) viral hepatitis B Annex no. 18 hereto,

E) of hepatitis C Annex no. 19 hereto,

F) chlamydia trachomatis Annex no. 20 hereto,

G) of invasive pneumococcal disease annex no. 21 hereto,

H) campylobacteriosis Annex no. 22 hereto,

I) Lyme borreliosis Annex no. 23 hereto,

J) shingles Annex no. 24 hereto,

K) rotavirus infections annex no. 25 hereto,

L) salmonellosis Annex no. 26 hereto,

M) acquired or congenital syphilis annex no. 27 hereto,

N) TBE Annex no. 28 hereto,

O) chickenpox (varicella) Annex no. 29 hereto,

P) of hepatitis E in Annex no. 30 hereto.

§ 4

The person providing care ^ 1) report public health authorities collected data about infections
according to § 2. If the suspicion and detection of each individual case
infectious disease according to § 3 shall proceed in
extent specified in Annexes no. 2-30 hereof.
Report is submitted within the time and in the manner specified by other legislation ^ 2).

§ 5

This decree comes into force on 1 January 2009.
Minister
:

MD. Julínek, MBA vr
Appendix 1


Infections that are included in the system of epidemiological vigilance

First DISEASES

01.01 Diseases preventable by vaccination:
Diphtheria


Infection that causes Haemophilus influenza type b and b non
Influenza

Measles

Mumps

Whooping cough


Polio
Rubella

Tetanus


02.01 Sexually Transmitted Diseases:
Chlamydia infections

Gonococcal infections


Infections caused by the human immunodeficiency virus (HIV / AIDS)

Syphilis (syphilis)

03.01 Viral hepatitis:


Hepatitis A Hepatitis B Hepatitis C Hepatitis E

04.01 Food- and water and diseases dependent on environment
:
Botulism

Campylobacteriosis

Cryptosporidiosis


Lambliasis (giardiasis)

Infections caused by E. coli Enterohaemorrhagic
Leptospirosis

Listeriosis

Salmonellosis

Shigellosis

Anthrax

Toxoplasmosis

Trichinosis



Yersiniosis Rotavirus infections


05.01 Other diseases:

1.5.1. Diseases transmitted by non-conventional agents
variant of transmissible spongiform encephalopathies (Creutzfeldt-Jakob disease)

1.5.2. Diseases transmitted by air


Legionellosis Meningococcal disease

Pneumococcal infections

Tuberculosis


Severe Acute Respiratory Syndrome (SARS)

1.5.3. Zoonoses (other than those listed in 1.4)
Brucellosis

Echinococcosis

Rabies


Bird flu transmitted to humans

West Nile virus infection


Q fever Tularemia

Lyme disease

Tick-borne encephalitis


1.5.4. Serious imported diseases
Cholera

Malaria

Mor

Viral hemorrhagic fevers


1.5.5. Other diseases
Chickenpox

Shingles

Appendix 2


System of epidemiological vigilance diphtheria

Art. 1

The clinical definition of the disease

First Clinical picture corresponding respiratory diphtheria (
febrile respiratory disease characterized
coating on the tonsils, throat or nasal mucosa in combination with sore throat and
elevated temperature) or diphtheria other sites (illness
characterized by cutaneous, conjunctival, ear, genital ulcers or sores
another type). Incubation period of 2-5 days.

Second Every case of diphtheria is clinically characterized by locating a
:

02.01 diphtheria throat;

02.02 diphtheria of the larynx - croup;

03.02 nasal diphtheria;

04.02 cutaneous diphtheria;

05.02 diphtheria other organs.

Third Infectiousness period lasts from the end of the incubation period, throughout
disease, usually 14 days, rarely more than 1 month.

Art. 2
Laboratory diagnosis


Laboratory diagnosis is performed isolation of Corynebacterium (C.
diphtheriae or C. ulcerans) from toxin-producing clinical specimen.
Investigating laboratory sends each strain C. diphtheriae and C. ulcerans in
National Reference Laboratory for diphtheria and pertussis further
determination.
Article 3

Epidemiological criteria


Epidemiological link - interpersonal transmission of a disease in which
one of the cases is laboratory confirmed.

Art. 4

Case classification of diseases

A. Possible: Clinically corresponding case

B. Probable: Clinically matching case in epidemiological context


C. Confirmed: Clinically matching case that is laboratory confirmed
isolation of toxigenic strain of Corynebacterium

For national surveillance is further defined

Symptomless carrier toxigenic strain

Art. 5

Data collection and reporting

Person providing care that diagnoses diseases diphtheria, reports
public health authorities confirmed and probable diseases including carriage
toxigenic strain and deaths from the disease, and it
cases of diphtheria Respiratory diphtheria and other sites as well as cases of asymptomatic carrier state
toxigenic strain. Cases with
nontoxigenic strains of C. diphtheriae or C. ulcerans should not be reported. Each
laboratory, which isolates of C. diphtheriae or C. ulcerans isolated reports
these agents under other legislation. ^ 2)

Art. 6

Epidemiological investigation on suspicion of occurrence of diphtheria

The person providing care ^ 1), which expressed suspicion of the disease
diphtheria, performs a swab from the point of clinical symptoms, such as tonsil,
nose, skin, culture examinations and ensure its transport immediately to the investigating
Labs. The investigating laboratory shall send each isolated
strain C. diphtheriae and C. ulcerans to verify and quantify
toxin production in the National Reference Laboratory for diphtheria and pertussis
. Epidemiological investigation, including control of vaccination coverage
ensure public health protection authority in particular in order to determine the source of infection and
transmission path.

Art. 7


Anti-epidemic measures in the outbreak of diphtheria

First Reports diseases subject under Article. 5 cases of diphtheria
respiratory tract diphtheria and other sites, as well as asymptomatic cases
carriage toxigenic strain.

Second Ensuring sampling of biological material to verify the diagnosis, his
transport to an investigative laboratory.

Third Isolation procedure regulated by other legislation ^ 2).

Fourth Baby after experiencing the disease can be admitted to kindergarten
schools, school facilities for institutional and protective education,
special children's facilities, social services and similar
equipment (hereinafter the "collective facilities") if the results of the clinical examination
health and the last two cultivation examination of the nose and throat
was negative in terms of C. diphtheriae and C. ulcerans (otherwise
only with the consent of the public health authorities, hereinafter "OOVZ").

Fifth After a period of 7 days is conducted medical surveillance for individuals who
been in contact with sick or carrier toxigenic strain.
At the beginning and end of the reporting period, a swab from the nose and throat to
microbiological examination.

6th For medical surveillance equipment to receive only unreceptive
children for diphtheria infection, susceptible children after 7 days, provided that the device
none of the children is not a carrier of toxic strain of C. diphtheriae.

7th Unreceptive children for diphtheria infection from families where the disease occurred
diphtheria may occur in equipment, children susceptible to diphtheria infection
up to 7 days after the last contact with the patient.
Appendix 3


System of epidemiological vigilance whooping cough
Article 1


The clinical definition of the disease

First Clinical picture corresponding pertussis, ie. A cough lasting at least two weeks
with one of the following symptoms: coughing, kokrhavý
cough or vomiting after coughing without other apparent cause or
apnea in infants. The incubation period of 7-21 days.

Second Typical form of pertussis:

Disease usually takes 6-8 weeks and has three stages: catarrhal (1-2 weeks
), paroxysmal (2-6 weeks) and convalescent (1-3 weeks).
Initial symptoms (runny nose, watery eyes, mild dry cough,
subfebrile) correspond to the symptoms of the common cold. During katarálního
stage a dry, irritating cough worsens and becomes paroxysmal coughing
- paroxysmal stage. The number and severity of seizures during this stage
rises. The bout was marked by a series of short expiratory completed
characteristic gulping protracted inspiration. Cough strokes are accompanied
emesis and vomiting occur both during the day and at night
. Convalescent stage is characterized by reducing the number of seizures and
alleviating cough. The most severe course of the disease is in children younger than 1 year
.

Third For children aged up to 15 years and adults with pertussis usually occurs in
lighter form. Runs like a dry, irritating cough lasting two or more weeks.
May be accompanied by vomiting and vomiting, but without the typical seizures.

Fourth Infectiousness period begins at the end of the incubation period, which lasts for 7 - 21 days
. It is highest in the early period katarálního stage, then gradually decreases
. Ends usually three weeks after the beginning of the paroxysmal stage
or five days after treatment with antibiotics.

Fifth Parapertuse unlike pertussis has lower manifestnost. Typical
course parapertuse reminds pertussis short catarrhal stage and
less paroxysmal stage.

Art. 2
Laboratory diagnosis


First Detection of specific antibody response against pertussis in persons
which have not been recently (within the previous eight weeks) vaccinated.

Second Detection of nucleic acid Bordetella pertussis.

Third Isolation of Bordetella pertussis (or B. parapertussis) from a clinical specimen
.

Fourth Standard laboratory test for the diagnosis of whooping cough is
culture of the Bordetella pertussis or B. parapertusis.

Fifth The serological examination shall be collected two blood samples at three-week intervals
. One sample was taken as soon as possible in the acute stage.
Prerequisite for serological diagnosis is currently testing the first and second
serum sample. Confirmation of ongoing disease is proven
significant (at least 4-fold) increase in antibody levels (against

Pertussis or parapertusi) or seroconversion from negativity to positivity
.

6th Any level of antibodies in a single sample is not acutely
evidence of ongoing disease.

7th The investigating laboratory shall send each isolated strain of B. pertussis and B. parapertussis
for verification to the National Reference Laboratory for pertussis and diphtheria
.

Art. 3
Epidemiological criteria


Epidemiological link - interpersonal transmission of a disease in which
one of the cases is laboratory confirmed.

Art. 4

Case classification of diseases

A. Possible: A case that meets the clinical case definition.

B. Probable: A case that meets the clinical case definition and has an epidemiological link
.

C. Confirmed: A case that meets the clinical case definition and is laboratory confirmed
.

Art. 5

Data collection and reporting

Person providing care that diagnoses the disease pertussis,
reported by public health authorities pertussis disease and death
this disease.

Art. 6

Epidemiological investigation on suspicion of incidence of pertussis

The person providing care ^ 1), which expressed suspicion of the disease
pertussis, ensuring clinical sample collection for culture or PCR
examination and will take blood samples for serological tests and ensure
transport of biological material immediately to investigating laboratory;
Least 3 weeks will carry out further blood tests. Caregivers ^ 1)
lab reports and investigating public health protection authority under Article
results. 4. The investigating laboratory shall send each isolated strain of B. pertussis and B.
parapertussis for verification to the National Reference Laboratory || | for pertussis and diphtheria. Epidemiological investigation, including checking
vaccination coverage will ensure public health protection authority in particular in order
identify the source of infection and transmission path.

Art. 7

Anti-epidemic measures in the focus of the disease pertussis

First Reports disease pertussis according to Art. 5

Second Ensuring sampling of biological material from a patient and contacts with
culture-positive patients, ensuring the transport of biological material
in the laboratory.

Third Isolation procedure regulated by other legislation ^ 2).

Fourth Baby after suffering a laboratory-proven disease caused by B. pertussis or B.
parapertussis is possible to adopt a collective
devices to negative culture tests, carried out a week after
treatment at intervals of 4-5 days.

Fifth To the collective facilities where the illness occurred pertussis, are accepted
unvaccinated or improperly vaccinated children for
maximum incubation period (21 days), not susceptible individuals infected through coughing
gag vaccinated properly and in terms they can the device occur.
Appendix 4


System of epidemiological vigilance measles

Art. 1

The clinical definition of the disease

First Clinical picture corresponding to the measles, ie.
Febrile illness with generalized rash lasting more than three days, preceded
catarrhal symptoms, temperature> 38 ° C and one or more of the following
symptoms: cough, runny nose, Koplíková spots, conjunctivitis.
Incubation period of 7-18 days.

Second Infectiousness period begins from the day before
prodromal symptoms and up to four days after the occurrence of rash.

Art. 2
Laboratory diagnosis


First Isolation of measles virus from a clinical specimen.

Second Detection of nucleic acid of measles virus in a clinical specimen
taken in the acute phase of the disease.

Third The presence of specific antibodies against measles virus
characteristic for acute infection in serum or saliva:

A) Detection of IgM antibodies against measles virus in people who were not in the last 6 weeks
vaccinated.

B) in order to license low levels of false positives spalničkových IgM
zarděnkových sporadic cases it is necessary to exclude possible
positive IgM antibodies to rubella virus, parvovirus B19, EBV and HHV-6
.

Fourth Proof of seroconversion or significant, rise
multiple levels of specific IgG antibodies spalničkových examination
pair sera (acute and convalescent) persons who are not in the last 6 weeks
vaccinated.


Fifth Detection increase the levels of pre-existing antibodies in the IgG spalničkových
reinfection.

6th Detection of measles virus antigen by direct immunofluorescence in
clinical sample taken in the acute phase of disease using monoclonal antibodies specific
measles.
To the correct interpretation of laboratory results should be taken into account also
clinical and epidemiological data, including vaccination status. When was the last
3-6 weeks vaccinated, it is necessary to consider testing
to non-vaccine virus. Measles virus isolates isolated from clinical
materials are sent to the National Reference Laboratory for Measles,
mumps, rubella and parvovirus B19 for further identification.

Art. 3rd
Epidemiological criteria


Epidemiological link - interpersonal transmission of a disease in which
one of the cases is laboratory confirmed.

Art. 4

Case classification of diseases

A. Possible: A case that meets the clinical definition of the disease.

B. Probable: A case that meets the clinical definition of the disease and
in epidemiological connection with a confirmed case.

C. Confirmed: A case that was recently (3-6 weeks)
vaccinated and is confirmed by laboratory results.

Art. 5

Data collection and reporting

Person providing care that diagnoses measles
reported by public health authorities illnesses and deaths from the disease
that meet the clinical and laboratory criteria. Due to
global eradication of measles ongoing need to identify
imported diseases and their epidemiological context.

Art. 6

Epidemiological investigation on suspicion of measles

The person providing care ^ 1), which expressed suspicion of the disease
measles performs sampling of biological material for laboratory
card etiology and ensure their transport to the investigating laboratory.
Investigating laboratory specimens examined with regard to another possible etiology
exantematických illness and laboratory-confirmed case
ensure sending an aliquot of serum to the National Reference Laboratory
for rubella, measles, mumps, and parvovirus B19 for confirmation.
The case was closed after examination by the laboratory.
Epidemiological investigation, including vaccination coverage control authority will ensure the protection of public health
particular in order to determine the source of infection and transmission path.

Art. 7

Anti-epidemic measures in the focus of measles

First Reports measles according to Art. 5

Second Ensuring sampling of biological material from a patient and contacts to
verification of diagnosis, ensuring the transport of biological material in the laboratory
.

Third Isolation of the patient for 7 days after the appearance of rash.
Isolation is carried out according to the severity of the clinical and epidemiological risks. Procedure
insulation covered by another piece of legislation ^ 2).

Fourth Active search for the source of infection and contacts aiming to stay
case during the time of his eventual exposure (7-18 days before the rash
) and the contacts he had in the period of infectiousness.

Fifth Epidemiological investigation of the focus of infection, usually within 48 hours after
reporting the case, including the identification of susceptible individuals still
persons.

6th Caregivers ^ 1) ensure the administration of human normal immunoglobulin
(NLIG) for children under 15 months of age (unvaccinated)
persons with permanent contraindications, pregnant women and persons with immunosuppression, which
been in contact with potential , probable or confirmed case of measles
, and according to the SPC.

7th Caregivers ^ 1) ensure vaccination of susceptible individuals
to measles (children who have not been given at least two doses of vaccine
) who have not yet expired three days after the last contact with the sick
. Exposure to measles is not a contraindication for vaccination.

8th In susceptible individuals to measles, which were in direct contact
, and which expired more than three days after the last contact with the sick
is carried out medical surveillance; medical supervision lasts for
maximum incubation period (21 days).

9th Impressionable children who have been in contact with measles will be accepted until
team after expiration of 21 days.
Appendix 5



System of epidemiological vigilance of influenza and acute respiratory infections

Art. 1

The clinical definition of the disease

First The clinical picture of infection by influenza viruses takes place through
influenza-like illness or in the form of acute respiratory infection.
Incubation time 1-4 days.

01.01 Influenza-like illness (ILI) is characterized by the following clinical signs
:

A) sudden onset of illness, while

B) at least one of symptoms, including fever or
chills, nausea, headache, myalgia, and simultaneously

C) at least one of the following respiratory symptoms, among which
include coughing, sore throat, shortness of breath.

02.01 Acute respiratory infection (ARI) is characterized by the following clinical signs
:

A) sudden onset of illness, while

B) at least one of the following respiratory symptoms, among which
include coughing, sore throat, shortness of breath, runny nose.

Second Infectiousness period in adults in the first to the fifth day
disease. In immunocompromised individuals and infants may be a period of infectiousness
until the tenth day of the disease.

Art. 2
Laboratory diagnosis


First Detection of influenza antigen, or nucleic acid in the tested
clinical material using EIA, immunofluorescence, PCR or other
adequate methods. Investigated the clinical material means
especially Nasopharyngeal swab, nasal swab, pharyngeal swab, nasopharyngeal aspirate
, endotracheal and brochoalveolární lavage.

Second Isolation of influenza virus from clinical specimens collected by culturing in
sensitive cell substrate (cell culture of chicken embryo);
isolated viruses are immediately sent to typing in the National Reference Laboratory for Influenza
established by the Ministry of Health.

Third Serological evidence of specific antibody responses against influenza
type A or type B consisting of at least four-fold rise in titer
antibodies in serum taken in the acute and convalescent stages
disease, and interval of at least 10 days. Suggested methods:
complement fixation reaction test hemagglutination inhibition, ELISA.

Fourth Detection of influenza virus in autopsy material, which is the trachea, bronchi or
bifurcation boundary zone pneumonického bearings.
Article 3

Epidemiological criteria


Epidemiological link - interpersonal transmission of a disease in which
one of the cases is laboratory confirmed. In the event of a flu epidemic
is not necessary laboratory evidence to confirm
epidemiological context.

Art. 4

Case classification of diseases

A. Possible: A case that meets the clinical definition of the illness (ILI or ARI
).

B. Probable: A case that meets the clinical definition
illness (ILI or ARI) and the epidemiological context.

C. Confirmed: A case that meets the clinical definition of the illness (ILI or ARI
), confirmed by laboratory results.

Art. 5

Data collection and reporting

The person providing care to diagnose the flu,
complications and deaths from the disease, according to another report done
legal regulation 2).

Art. 6

Epidemiological investigation on suspicion of flu and acute respiratory infections


First Pandemic OOVZ department conducted an epidemiological investigation
at all unusual occurrences of influenza, especially with the unusual
course in temporal and local context.
Conducted an epidemiological investigation of all reported deaths from the flu, and in direct relation with the flu and
determine whether sick or deceased person has been vaccinated against influenza before
current influenza season.

Second Caregivers ^ 1) in cooperation with the local authority
protecting public health, ensuring timely and performs sampling of biological material
to verify the diagnosis and its transport to the laboratory, which
basic investigation (direct antigen detection and insulating
attempt). Further tests conducted by the National Reference Laboratory for
flu.

Art. 7

Pandemic Influenza measures in the focus

First Reporting of the disease in Art. 5

Second Collection of biological material to verify the diagnosis and its transport to
appropriate laboratory for testing ensures and performs person providing

Care ^ 1).

Third In the case of the emergence of a new variant of the influenza virus is progressing according
Pandemic Plan of the Czech Republic for a pandemic flu
caused by a new variant of the influenza virus.
Annex 6


System of epidemiological vigilance of invasive meningococcal disease
(IMO)

Art. 1

The clinical definition of the disease

First Clinical picture corresponding meningococcal disease, i.e.
meningitis and / or meningococcal bacteremia, which can quickly progress to give
fulminant purpura, septic shock and death.
Other manifestations are possible. The incubation period of 2-7 days, exceptionally up to 10
days.

Second Invasive meningococcal disease include the following clinical manifestations
:

02.01 Meningococcal meningitis,

02.02 Waterhouseův-Friderichsenův syndrome

03.02 acute meningococcal bacteremia,

04.02 chronic meningococcal bacteremia,

05.02 meningococcal bacteremia,

2.6 meningococcal disease heart

07.02 other serious meningococcal infections, eg. pneumonia, septic arthritis
or

08.02 serious meningococcal infection unspecified.

Third Infectiousness period - during the whole period of the presence of meningococcal
secretions in the nose and mouth.

Usually disappear within 24 hours after the deployment of antibiotic treatment.

Art. 2
Laboratory diagnosis


First Isolation of Neisseria meningitidis primarily
sterile site (e.g. blood or cerebrospinal fluid, or less frequently, from articular,
pleural or pericardial fluid).

Second Detection of nucleic acid of N. meningitidis from primarily sterile
place.

Third Detection of N. meningitidis antigen from primarily sterile site.

Fourth Microscopic evidence of gram-negative diplococci from primarily sterile
place.

Fifth Due to the fact that the above clinical syndromes may be caused by a number
other etiological agents, the laboratory confirmation
etiology N.meningitidis necessary. It emphasizes the necessity of determining
agent to determine the level of serogroups of N. meningitidis. News on
culture testing is performed before deploying antibiotic therapy.

6th Strains of N. meningitidis isolated from clinical material, which is behind
normally sterile body fluids or obtained from
clinical manifestations (Art. 1), are sent to the National Reference Laboratory
for meningococcal disease created
Ministry of health for further evaluation. National Reference Laboratory for antibiotics
provides surveillance of antibiotic resistance.

Art. 3
Epidemiological criteria


Epidemiological link - interpersonal transmission of a disease in which
one of the cases is laboratory confirmed.

Art. 4

Case classification of diseases

A. Possible: A case that meets the clinical definition of the disease.

B. Probable: A case that meets the clinical definition of the disease and
epidemiological criterion.

C Confirmed: A case that meets the clinical definition of the disease and
least one of the laboratory criteria

Art. 5th

Data collection and reporting

Person providing care that diagnoses of invasive meningococcal disease
, reported by public health authorities illnesses and deaths
this disease. Asymptomatic carriage or a common respiratory disease with a
N. meningitidis is reporting.

Art. 6th

Epidemiological investigation on suspicion of occurrence IMO

The person providing care ^ 1), which expressed suspicion of invasive meningococcal disease
, done by collecting biological material for laboratory
card etiology and provide transport to the investigating
laboratory that isolates forwarded to the National Reference Laboratory
for meningococcal infection for further identification. National Reference Laboratory for antibiotics
provides surveillance of antibiotic resistance.
Epidemiological investigation authority will ensure the protection of public health, especially
to identify the source of infection.

Art. 7th

Pandemic measures in the focus of invasive meningococcal disease


First Reports disease invasive meningococcal disease in accordance with Art. 5

Second Ensuring sampling of biological material to verify the diagnosis, his
transport to the laboratory.

Third Immediate hospitalization and isolation of the patient. Isolation procedure
regulated by other legislation ^ 2).


Fourth Infection control measures are carried out in the presence of or under
suspicion at all invasive meningococcal disease among non-invasive
no anti-epidemic measures carried out.

Fifth When sporadic incidence of invasive meningococcal disease in
persons in contact with patients provides medical supervision for one week
since the last contact with the patient, advised to contact a doctor
in the development of symptoms including fever, || | recommendations to limit physical exertion.

6th At-risk individuals (those in close contact with sick people
to one year of age, adolescents, persons over 65 years of age, persons with known
immunodeficiency or other debilitation and persons with prior respiratory disease
) launch party providing care ^ 1) immediately protective
chemotherapy.

7th Upon the occurrence of invasive meningococcal disease caused by serogroup
against which the vaccine is available, the persons in contact with the vaccine offered
after about one week after the last contact with the sick
.
Annex 7


System of epidemiological vigilance of invasive disease caused by Haemophilus influenzae type
b and non-b

Art. 1

The clinical definition of the disease

Clinical picture corresponding to invasive disease, i.e. meningitis, epiglottitis
, sepsis, bacteremia, pneumonia, arthritis, osteomyelitis.
The period of communicability can be long, especially in asymptomatic carriers.
After initiation of therapy with potent antibiotics ending in 24 to 48 hours.
Incubation period of 2-4 days.

Art. 2
Laboratory diagnosis


First By culture of H. influenzae from clinical material, which is behind
normally sterile (cerebrospinal fluid, blood), or
body fluids of clinical manifestations (Art. 1).

Second By culture of H. influenzae from clinical specimens examined
in pneumonia: valid sputum sample or a sample obtained from
bronchoalveolar lavage (BAL) and hemokultivace.

Third Bezkultivační card antigens and / or nucleic acids of H. influenzae
from clinical material, which is normally sterile
(cerebrospinal fluid, blood), optionally in combination with a direct
microscopic identification.

Due to the fact that the above clinical syndromes may be caused by a number
other etiological agents, the laboratory confirmation
etiology of H. influenzae to level H. influenzae species and types
necessary. H. influenzae strains isolated from clinical material that
is normally sterile body fluids or obtained from
clinical manifestations in Article 1, they are sent to the National Reference Laboratory for
haemophilus infection for further determination .
National Reference Laboratory for antibiotics determines resistance to antibiotics. Subscriptions
biological material for culture examination is necessary before deploying
antibiotic therapy.

Art. 3
Epidemiological criteria


Not defined.

Art. 4

Case classification of diseases

A. Possible: A case with clinical epiglottitis without any laboratory
certificate or certificates only from non-sterile sites.

B. Probable: A case that meets the clinical definition of the disease and
in the above clinical material was demonstrated antigen
H. influenzae.

C. Confirmed: The Case of confirmed positive culture
examination and / or detection of H. influenzae nucleic acid from the above-mentioned
clinical material.

Art. 5

Data collection and reporting

Person providing care that diagnoses of invasive disease caused by H. influenzae
reported by public health authorities in case
illnesses and deaths from the disease.

Art. 6

Epidemiological investigation on suspicion of invasive disease caused
H. influenzae

The person providing care ^ 1), which expressed suspicion
invasive disease caused by H. influenzae performs sampling of biological material
on laboratory evidence of etiology and provide transport to the investigating
laboratory, which isolates transmit National Reference
lab for haemophilus infection for further identification. National Reference Laboratory for antibiotics
provides surveillance of antibiotic resistance.
Epidemiological investigation, including control authority shall ensure that proočkovannosti

Protection of public health, in particular in order to determine the source of infection.

Art. 7

Pandemic measures in the focus of invasive Haemophilus influenzae disease

First Reports disease invasive disease caused by Haemophilus influenzae
b and non-b according to Art. 5

Second Ensuring sampling of biological material and sending it to the appropriate
laboratory to laboratory.

Third Isolation of the patient. Isolation procedure governed by a different legal regulation
^ 2).

Fourth Medical supervision for 4 days from the last contact with the patient at
children under 6 years of age and learning about their legal representatives need
contact their physician if these symptoms occur
disease including increased temperature.

Fifth In children's preschools are accepted
susceptible children to disease caused by H. influenzae for a maximum incubation period of
elimination of a sick child.
Appendix 8


System of epidemiological vigilance of diseases caused by the human immunodeficiency
(HIV / AIDS)

Art. 1

The clinical definition of the disease

First The clinical picture of virus infections of the human immunodeficiency virus (HIV) extends
many years.

01.01 Disease caused by human immunodeficiency virus (AIDS).
Includes all persons infected with human immunodeficiency virus (HIV), which have
any of the clinical signs listed in the definition of cases European
surveillance AIDS.

02.01 Infection caused by human immunodeficiency virus (HIV).
Diagnosis is based on laboratory criteria of HIV infection.

Second Period of communicability lasts for the duration of being HIV positive.

Art. 2
Laboratory diagnosis


First Adults, adolescents and children aged 18 months and older

A reactive screening test (simultaneous detection of HIV-1/2 Antibody
and HIV-1 p24 antigen) source confirmed at the National Reference Laboratory for AIDS
established by the Ministry of Health.

A confirmatory test (simultaneous detection of HIV-1/2 antibodies and the HIV-1 p24 antigen
, Western blot and other blotingové tests, evidence of HIV-1 p24 antigen
including neutralization assay).

Detection of HIV nucleic acid (RNA or DNA).

Isolation of HIV.

Second Children younger than 18 months

Detection of HIV nucleic acid (RNA or DNA).

Detection of HIV-1 p24 antigen assay including neutralization.

Isolation of HIV.

Art. 3
Epidemiological criteria


Not defined.

Art. 4

Case classification of diseases

A. Possible: Not applicable.

B. Probable: Not applicable.

C. Confirmed: HIV infection Any person meeting the laboratory
criteria for HIV infection, AIDS: any person meeting the clinical criteria for AIDS
and laboratory criteria for HIV infection

Art. 5

Data collection and reporting

A National Reference Laboratory for AIDS in case of confirmation
HIV positive test result shall report:

First laboratory which carried out the search examination

Second the physician who tests ordained

Third physicians relevant AIDS center

Fourth a client who is left at the National Reference Laboratory for AIDS
investigate at their own request.

Fifth locally competent public health authorities

Doctor about AIDS center sent to the National Reference Laboratory for AIDS

First the first contact with HIV positive person completed form to:
reporting a new case of HIV positivity (also designated simultaneously announces
epidemiologist relevant KHS)

Second a change in clinical status and in the event of death of the completed form to:

Reporting clinical case of AIDS

Reports of deaths from HIV / AIDS.

About Laboratories performing screening tests for HIV
sent on the appropriate form to the National Reference Laboratory for AIDS
monthly reports on the number of tests, including data on investigation
population and used tests.

A National Reference Laboratory for AIDS data analyzes and transmits a
monthly reports on the incidence of HIV / AIDS in the form of tables and charts
Ministry of Health, Institute of Health Information and Statistics
twice a year on the website of the State
health Institute. National Reference Laboratory for AIDS data on the incidence of HIV / AIDS in the Czech Republic
report to the European Monitoring Centre.

Art. 6

Epidemiological investigation on suspicion of HIV / AIDS


The person providing care ^ 1), which expressed the suspected infection
HIV / AIDS, will take blood samples to investigate the presence of antibodies.
Epidemiological surveys provide caregivers ^ 1) or the authority
protect public health, especially to determine the source of infection and transmission path
.

Art. 7


Measures Pandemic
First Reports diseases caused by the human immunodeficiency virus
(HIV / AIDS) in accordance with Art. 5

Second Anti-epidemic measures consist of a specific application
prevention activities in a given population.

Third Caregivers ^ 1) to ensure examination of persons injured
a used needle, according to the table.
----------------------------------------------- - ------------------------------------------------ | || examined within 72 hours after injury 90 days after injury within 180 days after the injury
----------------------------- ------------------- ------------------------------- -----------------
hepatitis B Yes Yes Yes *
hepatitis C Yes Yes Yes Yes Yes HIV
No
---- -------------------------------------------- ------ ------------------------------------------

* U injured persons with proven protective titer of anti-HBs after immunization, or living
infection with other investigations of HBV markers quits.

When the negative outcome markers HBsAg, anti-HCV and anti HIV among
potential source, if known, the monitoring of injured persons
quits. Part of the examination is to determine
subjective complaints and clinical symptoms that may be associated with disease, viral hepatitis and
laboratory tests aminotransferase activity.
Event is always recorded in the medical records of injured persons.
Appendix 9


System of epidemiological vigilance tuberculosis

Art. 1

The clinical definition of the disease

Clinical criteria TBC meets every person both criteria 1, 2 or 3 criteria
:

First The doctor will decide that the clinical signs or radiological findings correspond
Tuberculosis and

Second doctor's decision to treat the patient complete antituberculotic
treatment or

Third Post-mortem findings of pathological changes that would
patient's life triggered the antituberculotic treatment.

Art. 2
Laboratory diagnosis


Laboratory diagnosis involves culture of the microorganism
Mycobacterium tuberculosis complex (excluding Mycobacterium bovis BCG
) from any clinical specimen.
Severity increases
finding microscopic evidence of acid-fast bacilli
from any clinical specimen, especially from spontaneous or induced sputum
.

Within laboratory diagnostics can be used as a rapid diagnostic tests
card tubercle bacilli type Bactec - MGIT and MB / BacT, tests
detection of mycobacterial DNA / RNA testing and compliance interferon gamma (IGRA tests
) as well as histological examination.

U bacteriologically verified cases is conducted investigations
sensitivity to antituberculotic.

U isolated strains of Mycobacterium tuberculosis test results are
sensitivity antituberkulotika source confirmed at the National Reference Laboratory for Mycobacteria
. To eliminate or confirm
multidrug-resistant or extensively drug-resistant tuberculosis carried
mycobacterial laboratory isolate and M. tuberculosis susceptibility testing
even strains isolated from autopsy material or
strains isolated from clinical specimens persons during
laboratory tests died.

First Laboratory criteria for a confirmed case.

Fulfilled at least one of the following two criteria:

01.01 Insulation (cultivation) of Mycobacterium tuberculosis complex (with the exception
Mycobacterium bovis-BCG) from a clinical specimen material.

02.01 Nucleic acid detection of M. tuberculosis complex in clinical
sample of material and the finding of acid-fast bacilli (ART) in direct
microscopy sample.

Second Laboratory criteria for a probable case.

Fulfilled at least one of the following three criteria:

02.01 The finding of acid-fast bacilli (ART) in direct microscopy sample.

02.02 Nucleic acid detection of M. tuberculosis complex in clinical
sample material.

03.02 The finding of granulomas (granulomatous changes)
by histological examination.

Art. 3
Epidemiological criteria


Not defined.

Art. 4


Case classification of diseases

A. Possible: A case that meets the clinical definition of the disease.

B. Probable: A case that meets the clinical definition of the disease and
laboratory criteria for a probable case.

C. Confirmed: A case that meets the clinical definition of the disease and
laboratory criteria for a confirmed case.

First Classification according to infectivity.

01.01 The case of the infectious form of TB disease:

1.1.1. a person with TB in sputum negative or other material bacilli
M. tuberculosis complex, proven by culture and especially culture and
microscopically.

02.01 The case of well-founded suspicion of infectious diseases TB:

1.2.1. a person with a finding suggestive of active pulmonary TB (X-ray finding
histology etc.), in which sputum culture results or other
material are not yet finalized, or

1.2.2. a person with a finding suggestive of active pulmonary TB, for which
material for bacteriological examination was obtained, or

1.2.3. a person with finding and shows that the only active extrapulmonary TB, with
which is reasonable suspicion excretion of tubercle bacilli in
bodily secretions or excretions into the external environment.

03.01 Case unproven infectivity:

1.3.1. a person with a finding suggestive of active pulmonary TB closed
mykobakteriologickým examination with negative results.

04.01 The case of the unlikely infectivity:

1.4.1. a person with finding and shows that the only active extrapulmonary TB except
circumstances described in paragraph 1.1.1. and 1.2.3.

Second Classification according to localization of the disease.

2.1 Pulmonary tuberculosis:

Tuberculosis of the lung parenchyma or the tracheo-bronchial tree or
larynx.

2.2 Extrapulmonary tuberculosis:

Tuberculosis any location other than that specified in paragraph 2.1, including
pleural tuberculosis and intrathoracic lymph nodes without disabilities
pulmonary parenchyma.

2.3 Disseminated tuberculosis is classified as pulmonary tuberculosis
if the affected lung parenchyma or the tracheo-bronchial tree or
larynx, in other cases it is classified as extrapulmonary tuberculosis
.

2.4 Respiratory tuberculosis:

Pulmonary tuberculosis or tuberculosis, pleural tuberculosis
intrathoracic lymph nodes.

Third Classification according to previous antituberculotic treatment.

3.1 naïve (a)

Person who has never been previously treated for active tuberculosis
antitubeculotics, or taking medicines against tuberculosis
less than one month.

Previously treated with 3.2 (a):

Person, which has been previously diagnosed with active tuberculosis, and
which used anti-tuberculosis drugs (excluding preventive therapy)
least one month.

Art. 5

Data collection and reporting

Person providing the care, which initiates treatment, reports
body for protection of public health tuberculosis. In other cases where
treatment is not started, reports of tuberculosis doctor who diagnosed the disease
. Tuberculosis deaths reported by the person providing the care
^ 1).

Art. 6

Epidemiological investigation on suspicion of tuberculosis

First Caregivers ^ 1), which expressed suspicion of the disease
infectious form of tuberculosis makes medical history, clinical and radiographic findings and
provide transportation to the inpatient facility that
patient isolates. Furthermore, it ensures epidemiological investigations in particular in order
identify the source of infection and transmission path. In cases of infectious TB
diseases, especially smear positive, with a range exceeding outbreak
family connections, cooperate closely in the epidemiological investigation
with public health authorities.

Second The attending physician shall also ensure collection of biological material on
microscopic examination and culture, ensuring its
transport immediately to the laboratory and, where appropriate, ensure implementation of the tuberculin skin test and possibly
IGRA test.

Third Attending physician inpatient, Dispensatory doctor
responsible for the examination of contacts, public health protection authority,
possibly other body involved in the examination of contacts
collect the data necessary for the examination of contacts.

Art. 7

Anti-epidemic measures in the focus of infection

First Reports of tuberculosis according to Art. 5


Second Anamnesis, clinical, radiographic examinations contacts.

Third Further testing for contacts and administration of chemoprophylaxis according
valid recommendations.

Fourth When epidemiologically significant occurrence in the investigation and determination
measures involved in public health protection authority.
Annex 10


System of epidemiological vigilance legionellosis

Art. 1
The clinical definition of legionellosis


First Legionnaires' disease - an acute lower respiratory tract illness with symptoms of pneumonia
diagnosed clinically, radiographically,
laboratory. Incubation period of 2-10 days.

Second Pontiac fever - an acute legionella infection without disabilities
lower respiratory tract. Incubation period of 1-2 days.

Art. 2
Laboratory diagnosis


At least one of the following criteria:

First Direct detection of antigen in urine.

Second Detection of specific antibodies in serum.

Third Direct detection of microbes in respiratory secretions.

Fourth Culturing on selective soils.

Fifth Strain typing sent to the National Reference Laboratory for Legionella with
sequencing.

Art. 3rd
Epidemiological criteria


Exposure to the same common reservoir as the confirmed case.

Art. 4

Case classification of diseases

A. Possible: Not applicable.

B. Probable: meets the above definition of clinical disease
epidemiological criterion and at least one of the following laboratory criteria
:

First four-fold or greater increase in antibody to L. pneumophila
serogroups other than sg. 1 or other kinds
confirmed by indirect immunofluorescence or mikroaglutinací;

Second high titers of antibodies to L. pneumophila sg.
1 or other serogroups or species;

Third card specific agent in the respiratory secretions and lung tissue
using direct fluorescence with monoclonal antibodies;

Fourth card Legionella in biological material by molecular biological
accredited methods (PCR).

C. Confirmed: meets the above definition of clinical disease and
one or more of the following laboratory criteria:

First Legionella isolation from bronchoalveolar lavage, sputum, pleural
fluid, lung tissue, blood or other biological material;

Second four-fold or greater rise in specific antibody titers
Legionella pneumophila sg. 1 confirmed by indirect immunofluorescence,
mikroaglutinací or ELISA;

Third Card-specific antigen in urine validated diagnostic kit
.

Other legionella classification for the purposes of the national system of epidemiological vigilance
:

A. Nosocomial legionellosis - the patient was infected in a health care facility
.

B. Travel legionellosis - the patient was infected during a one-day or multiple-day
stay in a hotel or other accommodation facilities mass
country or abroad, where he stayed from 2 to 10 days before the appearance of clinical symptoms
.

C. Professional legionellosis - infections that occurred during work.

D. The community of legionellosis - contagion from other reservoirs.

E. Other.

Art. 5

Data collection and reporting

The person providing care ^ 1), which diagnoses diseases legionellosis,
immediately report to public health authorities illnesses and deaths
this disease.

Art. 6

Epidemiological investigation on suspicion of the incidence of legionellosis

The person providing care ^ 1), which expressed suspicion of the disease
legionellosis, performs sampling of biological material (bronchoalveolar lavage
, sputum or pleural effusion, urine, blood, or other bodily fluids
, if deaths from the affected part of the lung tissue deposits)
laboratory to license etiology and ensure their transport to the laboratory
investigating. Cultured strains, possibly taken
biological material passes Laboratory to the National Reference Laboratory for Legionella
for identification and typing or processing.
Epidemiological investigation authority will ensure the protection of public health, especially
to determine reservoir of infection and transmission path.

Art. 7

Anti-epidemic measures in the outbreak of diseases legionellosis

First Reports diseases legionellosis under Article 5.

Second Ensuring sampling of biological material to verify the diagnosis, his
transport to the laboratory.


Third Epidemiological investigation of the outbreak of the disease, including the definition
other vulnerable persons, checking the travel history, sampling water from
technical facilities, a proposal for a technical revision. ".
Annex 11


System of epidemiological vigilance polio (poliomyelitis)

Art. 1

The clinical definition of the disease

First Clinical picture corresponding poliomyelitis, ie. An acute onset of poor
paralysis of one or more limbs with decreased or absent tendon reflexes
in the affected limb without apparent cause and without loss
sensory or cognitive function.

Second The acute form of poliomyelitis is defined as:

02.01 acute paralytic poliomyelitis associated with vaccination (a vaccination
substance);

02.02 Acute paralytic poliomyelitis, wild virus imported;

03.02 Acute paralytic poliomyelitis, wild virus Unimported
(domestic);

04.02 Acute paralytic poliomyelitis;

05.02 neparalytická acute poliomyelitis;

06.02 Acute polio in people younger than 15 years.

Third The incubation period of the emergence of paralysis is five to twelve days.
Period of infectivity lasts from the last days of the incubation period.
Virus excretion nasopharyngeal secretions lasts about one week and faeces up to 6 weeks. Virus
also exclude persons with asymptomatic infection (ie. 80% of all infected
). Paralytic form occurs in only 1% of those infected.
Article 2


Laboratory diagnosis of at least one of the following three criteria:

First Isolation of poliovirus from a clinical sample and its intratypová
differentiation - Wild polio virus (WPV)

Second Virus derived from vakcinálního strain (VDPV) - at least 85% compliance with
vaccinal virus in the nucleotide sequence of VP1

Third Sabin-like poliovirus: intratypická differentiation made WHO
accredited laboratory (for VDPV> 1% to 15% VP1 sequence difference compared
vaccinal virus of the same type)

Poliovirus isolates isolated from clinical samples are sent to
National Reference Laboratory for enteroviruses for further identification.

Art. 3rd
Epidemiological criteria


At least one of the following epidemiological links:

- Transmission from person to person

- Traveling in an area with endemic polio or areas with
presumed or confirmed circulation of poliovirus.

Art. 4

Case classification of diseases

A. Possible: A case that meets the clinical case definition

B. Probable: A case that meets the clinical case definition with
epidemiological connection with a confirmed case

C. Confirmed: A case that meets the clinical case definition and is laboratory confirmed


Other data for national surveillance:

- Imported cases - the source of infection outside the Czech Republic, paralytic disease
take effect 30 days after the arrival from abroad, especially from areas
endemic poliomyelitis.

- Contact is carried by the case - the source of infection is sick with
by imported case of paralytic poliomyelitis.
Paralytic disease, contacts occur within 30 days after the onset of paralytic poliomyelitis
deported case.

- Cases related to vaccination with live polio vaccine
(VAPP)

A) the recipient - if ill-paralytic poliomyelitis
person vaccinated in time from 4-30 days after vaccination

B) contact - if ill-paralytic poliomyelitis person who
in the last 30 days alone have not been vaccinated but has been in contact with a person vaccinated
who received a live vaccine in the last 60 days.

Case nezavlečený and no vaccine-related ( "home").

Art. 5

Data collection and reporting

Person providing care that diagnoses the disease poliomyelitis
reported by public health authorities illnesses and deaths from the disease
. Within the system of epidemiological vigilance
poliomyelitis was reported and is being investigated as well as cases of acute flaccid paresis to 15 years of age.

Art. 6

Epidemiological investigation on suspicion of incidence of poliomyelitis

The person providing care ^ 1), which expressed suspicion of the disease
poliomyelitis, done by collecting stool and ensure sending subscribe to
National Reference Laboratory for enteroviruses. The investigating laboratory
send the isolated strain of poliovirus into the regional reference laboratory for

Enteroviruses in the World Health Organization for Europe.
Epidemiological investigation, including control of vaccination coverage
authority will ensure the protection of public health, in particular to identify the source of infection and transmission path
.

Art. 7

Anti-epidemic measures in the outbreak of poliomyelitis

First Reports disease.

Second Ensure collection of biological material (feces) to verify the diagnoses
and have it sent to the National Reference Laboratory for enteroviruses.

Third Isolation procedure regulated by other legislation ^ 2).

Fourth Securing vaccinate people against poliomyelitis have been in close contact with
patients regardless of whether they were previously vaccinated.
In the event that it is highly suspected case of poliomyelitis or
highly suspected case of acute flaccid paresis, carry out vaccination against poliomyelitis
only unvaccinated people or to those who received less than
3 doses of polio vaccine.

Fifth An investigation in the outbreak.

6th Medical supervision for 35 days after the last contact with a confirmed case of paralytic poliomyelitis
. For persons performing activities epidemiologically serious
is dictated by the increased medical supervision for 6
weeks after the last contact with a confirmed case of paralytic poliomyelitis
.
Annex 12


System of epidemiological vigilance tetanus

Art. 1

The clinical definition of the disease

First Clinical picture corresponding tetanus, ie. An acute onset of hypertension
and / or painful muscular contractions (usually at the jaw and neck muscles
) and / or generalized muscle spasms without
obvious health reasons. The incubation period of 3-21 days.

Tetanus meets clinical definition of a person with at least two of the following three criteria
- painful muscle spasms of masticatory and neck muscles
leading to the facial spasm (trismus and "rhisus sardonicus")
painful spasms trunk muscles , generalized spasms (often
opisthotonus).

Second In terms of clinical tetanus each case classified as:

02.01 localized tetanus, characterized by increased muscle tonus
only certain muscle groups of the gateway infection or
just isolated Trisma;

02.02 generalized tetanus light, characterized by general muscular hypertonia
, but the absence of generalized convulsions;

03.02 generalized tetanus moderate, characterized by the presence
generalized convulsions at a frequency less than 1 times per hour, without
dysphagia and cyanosis;

04.02 generalized tetanus heavy, characterized by the presence
generalized convulsions in the frequency of more than 1 time per hour with dysphagia
and cyanosis.

Clinical classification in Section 2.1. up 2.4 can be performed first
seventh day after the onset of symptoms.

Third Infectiousness period: the disease is not transmitted from person to person.
Article 2

Laboratory diagnosis


Bacteriological examination to isolate the causative agent of sampling
anticipated entry gates infection if it is found, and it
culture or animal experiments, the negative result of the laboratory examination
signifies that the clinical diagnosis. Detection of tetanus toxin in
serum. The investigating laboratory shall send each isolated strain of C. tetani in
National Reference Laboratory for tetanus.

Art. 3
Epidemiological criteria


Not defined.

Art. 4

Case classification of diseases

A. Possible: Not applicable.

B. Probable: Clinically corresponding case.

C. Confirmed: A case with clinical and laboratory criteria.

Art. 5

Data collection and reporting

Person providing care that diagnoses tetanus, reported
public health authorities this disease and deaths from the disease
.

Art. 6

Epidemiological investigation on suspicion of the incidence of tetanus

Caregiver ^ 1), which expressed a suspected disease
tetanus, ensuring the removal of material for bacteriological examination to try to demonstrate
Clostridium tetani in the wound (if established
injury that was probably gateway infection)
either cultivation or animal experiments. Further ensure the collection of blood on
serological examination. Immediately ensure the transport of biological material
to the appropriate investigating laboratory. epidemiological investigation

Including control of vaccination coverage will ensure public health protection authority, especially
to determine the route of transmission.

Art. 7

Pandemic their response to tetanus

First Reports tetanus according to Art. 5

Second Ensuring the sampling of biological material from a patient to verify
diagnosis, transport to the laboratory.

Third Isolation procedure regulated by other legislation ^ 2).
Annex 13


System of epidemiological vigilance of rubella and congenital rubella syndrome
(CoP)

Art. 1

The clinical definition of the disease

First rubella

Clinical picture corresponding rubella, ie. The acute onset of generalized maculopapular rash
(rash) and at least one of the following
symptoms: arthralgia, arthritis, cervical, and subokcipitální
postaurikulární lymphadenopathy. It can also occur conjunctivitis.
Incubation period of 14-21 days.

Second Congenital rubella syndrome (CoP)

Risk of harm to the fetus depends on the mother's immunity and pregnant
at the time of her infection. When maternal disorders (i inapparent)
the first month of pregnancy, it is obviously damaged more than 50% of newborns at
disease in the second month, 25% in the third month and 10% in the fourth month
less than 5% newborns. Rubella virus infection can lead to
intrauterine fetal death, spontaneous abortion and congenital malformation
large systems or childbirth apparently healthy fetus, at which
congenital infection manifests later in life
impaired vision, hearing loss or mental retardation and others. the classical expression KZS
Gregg's syndrome, ie. combined incidence of congenital malformations of the heart (open
dučej arterial, pulmonary stenosis or aneurysm, cardiac septal defects)
eye (cataract, microphthalmos, glaucoma, retinopathy) and the deafness or hearing loss
(and unilateral). There are also microcephaly and
dental abnormalities, hepatosplenomegaly, meningoencephalitis, thrombocytopenic purpura
, myocarditis, hepatitis, osteoporotic changes
metaphyses of long bones. Affected children tend to have lower birth weight, poorly
thrive. For congenital rubella syndrome in children under 1 year of life
need to meet at least two of the following clinical criteria
listed in paragraph A or one criterion of paragraphs A and one from Section B
:

A. cataract, congenital glaucoma, congenital heart defects, disorders
hearing, pigmentary retinopathy

B. purpura, splenomegaly, microcephaly, mental retardation,
meningoencephalitis, osteoporotic changes metaphyses of long bones
jaundice starting within 24 hours after birth.

Third Period of infectiousness:

03.01 for varicella about 1 week before the appearance of rash and minimally 4
days after its start;

03.02 u KZS - children can excrete the virus in their secretions and urine faryngeálním
months after birth,

Exceptionally throughout the first year of life, in the case of cataract until
three years of life.

Art. 2
Laboratory diagnosis


First Criteria for a confirmed case of rubella:

A. Isolation of rubella virus in individuals who have not been in the past 6 weeks
vaccination, one week before and up to 1 week after the appearance of rash.
The material for the direct detection of rubella are best swabs from the throat
different samples of blood, urine and cerebrospinal fluid swabs from the nose.
Samples must be taken as soon as possible.

B. Detection of nucleic acid nevakcinálního rubella virus in clinical
sample taken in the acute phase of the disease.

C. Proof of seroconversion or significant, několinásobného rise
levels of specific IgG antibodies zarděnkových examination pair
samples of serum or saliva for people who were not in the last 6 weeks of vaccination. Proof
increase existing levels of IgG antibodies in zarděnkových
reinfection.

Second The criteria for a probable case of rubella:

Detection of IgM antibodies to rubella virus in people who were not in the last 6 weeks
vaccinated. In case of suspected rubella in pregnancy
need further confirmation of positive test results for IgM
(eg. Specific test avidity IgG antibodies to rubella
showing a low avidity).

Third Criteria for congenital rubella syndrome (CoP)

A. Isolation of rubella virus from a clinical specimen.

B. Detection of Rubella virus nucleic acid.

C. The presence of specific IgM antibodies to rubella virus.


D. The persistence of IgG antibodies to rubella between the sixth and twelfth
months of age (at least two samples with similar concentration
IgG rubella).

Rubella virus isolates isolated from clinical samples are sent to
National Reference Laboratory for Measles, mumps, rubella, and parvovirus B19
for further identification.
Article 3

Epidemiological criteria


Epidemiological link - interpersonal transmission of a disease in which
one of the cases is laboratory confirmed.

In congenital rubella syndrome involves epidemiological
interpersonal relationship in the vertical transmission of the disease from mother to fetus
.

Rubella infection is laboratory evidence of the mother during pregnancy
.

Art. 4th

Case classification of diseases
Rubella


A. Possible: A case that meets the clinical case definition

B. Probable: Clinically matching case which has
epidemiological link and / or laboratory meets the criteria

C. Confirmed: Clinically matching case that is laboratory confirmed


Congenital rubella syndrome (CoP)

A. Possible: A child younger than one year, at which a diagnosing physician
suspected KZS. Diagnosing physician expresses suspicion KZS if
child's mother has a history of suspected rubella during pregnancy, and
even if the child shows no signs of CoP.

B. Probable: A child under one year (i stillborn fetus)
without laboratory examination or laboratory examinations with negative
least one of the following two criteria:

- Epidemiological linkage and at least one of the clinical criteria KZS
referred to in Article 1, Section 2A,

- Met clinical criteria for KZS,

C. Confirmed: a stillborn fetus with a positive laboratory finding
or a child under one year of meeting the laboratory criteria and at least one of the following
:

- Epidemiological context

- At least one of the clinical criteria KZS listed in Article 1, paragraph 2A


Note: A child with a positive laboratory finding disease-free
rubella in the mother during pregnancy and without clinical criteria KZS
referred to in Article 1, Section 2A will be reported as a case of illness
rubella.

Art. 5

Data collection and reporting

The person providing care to diagnose the disease rubella or
KZS, reported by public health authorities illnesses and deaths from the disease
.

Art. 6

Epidemiological investigation on suspicion of occurrence of rubella and KZS

The person providing care ^ 1), which expressed suspicion of the disease
rubella or CoP performs sampling of biological material and ensure their transport to
investigating laboratory. Epidemiological investigation
including control of vaccination coverage to ensure public health protection authority.

Art. 7

Anti-epidemic measures in the outbreak of diseases and rubella KZS

First Reports disease rubella and KZS according to Art. 5

Second Ensuring the collection and transport of biological material or sick
congenital Rubella syndrome or congenital rubella infection
disabled child to verify the clinical diagnosis in the appropriate
virological laboratory.

Third Isolation of sick mostly in home insulation.

Fourth The first clinical tests of a sick child from collective facilities
second after 3 weeks.

Fifth After 3 weeks from the elimination of a sick child is carried by individuals
persons who were in contact with patients, medical supervision.

6th For health surveillance devices to accept all children except children
weakened.

7th Children from families where the disease occurred rubella, can cause the device to
.

8th After the baby has stopped the disease rubella may be taken into
devices after approval by the attending physician.

9th In the case of CoP guidance on ensuring the protection of fertile and pregnant women
susceptible to rubella in contact with the patient.
Annex 14


System of epidemiological vigilance mumps

Art. 1

The clinical definition of the disease

First Clinical picture corresponding to the mumps include fever with the acute onset of unilateral or
sided, touch-sensitive,

Circumscribed swelling parotid or other salivary gland, lasting more than two days
no other obvious causes. Exceptionally, it may be
disease complicated by orchitis, meningitis, pancreatitis and oophoritidou,
very rarely, encephalitis. The incubation period of 16-18 days.

Second Period infectivity: Saliva 7 days before and 9 days after the beginning
disease. Inapparent patients may also be a source of infection.

Art. 2
Laboratory diagnosis


First Direct detection nevakcinálního strain of mumps virus isolation from clinical
sample taken in the acute phase of the disease.

Second Detection of nucleic acid nevakcinálního strain of mumps virus in
clinical sample, taken during the acute phase of the disease.

Third Detection of IgM antibodies against mumps virus in people who were not in the last 6 weeks
vaccinated.

Fourth Proof of seroconversion or significant, rise
multiple levels of specific IgG antibodies parotitických examination
pairs of samples of serum or saliva of people who were not in the last 6 weeks
vaccinated.

Fifth Detection increase existing levels of IgG antibodies parotitických
u reinfection.

6th Antigen detection nevakcinálního strain of mumps virus (DFA) using
parotitických specific monoclonal antibodies in a clinical
sample taken in the acute phase of the disease.

A correct interpretation of laboratory results should be taken into account
also clinical and epidemiological data, including vaccination status. ".

Art. 3rd
Epidemiological criteria


Epidemiological link - interpersonal transmission of a disease in which
one of the cases is laboratory confirmed.

Art. 4

Case classification of diseases

A. Possible: A case that meets the clinical definition of the disease.

B. Probable: A case that meets the clinical definition of the disease and
in epidemiological connection with a confirmed case.

C. Confirmed: A case confirmed the result of the laboratory examination or
case confirmed by detecting a wild strain of mumps virus in case
recent vaccination.

Art. 5

Data collection and reporting

The person providing care to diagnose mumps,
reported by public health authorities illnesses and deaths from the disease
.

Art. 6

Epidemiological investigation on suspicion of the incidence of mumps

The person providing care ^ 1), which expressed suspicion of the disease
mumps performs sampling of biological material for laboratory
card etiology and ensure their transport to the investigating laboratory.

Art. 7

Anti-epidemic measures in the focus of mumps

First Message mumps according to Art. 5

Second Ensuring the collection and transport of biological material
patient to verify the clinical diagnosis in the appropriate virological laboratory

Third Isolation of patients with uncomplicated cases at home for nine days beginning
illness, hospitalization, according to clinical severity and
epidemiological risks.

Fourth The first clinical tests of a sick child after his exclusion from collective
device, second after 3 weeks.

Fifth After 3 weeks from the elimination of a sick child from collective
device is made for individuals who were in contact with patients, medical
supervision.

6th For health surveillance devices to accept all children except
debilitated children.

7th Children not susceptible to mumps infection can to collective facilities
occur.

8th Children not susceptible to mumps infection from families where the disease occurred
mumps can lead to the device.

9th Child susceptible to infection with mumps may cause the device to day 8.
after the first contact with the patient, unless the permanent contact (when in permanent contact
attendance immediately stops) and from 21 days after the last contact with | || sick. In permanent contact with the infection after the last day of intercourse is considered
9th Day after parotid gland swelling.

10th The child ceased after mumps may be taken into
devices after approval by the attending physician.
Annex 15


System of epidemiological vigilance of infections caused by West Nile virus
fever (hereinafter "WNV")

Art. 1

The clinical definition of the disease

First Clinical picture corresponding febrile disease with neurological

Symptoms, ranging from strong headaches and muscle
after aseptic meningitis or encephalitis, with an incubation period of 2-6 days,
maximum range of 2 to 15 days after exposure, which is conditional on strike || | mosquito, tick bites rarely genus Hyalomma or transfer agent
from human to human transplants, transfusions or the placenta. Other
WNV transmission from human to human transmission than blood and tissues
is not considered to be realistic.

Most infections take place inapparent, approximately 20% of cases
manifested by maculopapular rash and lymphadenopathy, disability
central nervous system is less than 1% of the clinically manifest disease
. In a typical course of the disease lasts for 2-7 days.

Second Viremia reaches its peak at the time of the appearance of the first symptoms during
next 4-6 days, gradually decreasing concentrations
virus to an insignificant level. It is believed that immunity after overcoming
disease lasts throughout life, however, it was demonstrated a gradual decline in titer
specific protective antibodies.

Art. 2
Laboratory diagnosis


First Detection of specific antibody response (serum, liquor).

Second Detection of nucleic acids in blood or CSF.

Laboratory criteria for probable case:

First Determination of IgM antibodies against WNV in the serum by ELISA.

Second Determination of IgG antibodies against WNV in the serum by ELISA.

Third Determination of antibodies against WNV in the serum hemagglutination inhibition assay
HIT.

Laboratory criteria for a confirmed case:

First Demonstration of specific IgM antibodies to WNV in cerebrospinal fluid
.

Second Isolation of WNV from blood or CSF.

Third Detection of WNV nucleic acid in blood or CSF.

Fourth Positive virus neutralization test.

The collected biological material (possibly serum CSF)
sends the appropriate medical facility in the National Reference Laboratory for arboviruses.

Laboratory results should be interpreted depending on the condition
possible vaccination against certain diseases caused by other flaviviruses, or
exclude recent infections diseases mentioned (tick-borne encephalitis
, yellow fever, Japanese B encephalitis, dengue).

Art. 3
Epidemiological criteria


At least one of the following epidemiological links:

First Transmission from animals to humans (residing, visiting or exposure
bites by mosquitoes in endemic WNV in horses and birds
or places with extreme overcrowding mosquitoes, especially in the context of
flooding, exceptionally transmission of tick bites )

Second Transmission from person to person (transplants, blood transfusions, or
placenta).

Art. 4

Case classification of diseases

A. Possible: Not applicable.

B. Probable: Any person meeting the clinical criteria and
least one of the following two situations:

First epidemiological context

Second at least one of the laboratory criteria for a probable case.

C. Confirmed: Any person meeting the clinical criteria and at least one of the criteria for
laboratory confirmed case.

Art. 5

Data collection and reporting

First Caregivers ^ 1) to diagnose WNV infection, according
criteria in Articles 1-3, reported by public health authorities
confirmed and probable cases of disease or deaths from the disease
. With regard to global changes in the geographical distribution of disease vectors
be consistently detect and report data related to
relevant travel history of disabled persons and data that
may be related to potential interpersonal transmission of the infectious agent | || (transplantation, transfusion, or placental transfer).

Second Locally competent public health protection authority shall be promptly
transmission of information about confirmed cases of WNV to all workplaces gravity
transfusion service previously agreed manner and at the same time
informs the Ministry of Health.

Third The Ministry of Health will ensure based on the reports it receives
via the rapid alert system of the European Commission (EWRS) and
through other similar systems, transmitting information about
current epidemiological situation in the occurrence of human cases of WNV infection
abroad to all workplaces transfusion services and protection bodies
public health in the country.


Art. 6

Activities transfusion service

Transfusion service will provide:

) Exclusion from donation of whole blood and blood components for all persons
who resided in areas with ongoing transmission of WNV to humans, after
28 days after leaving such areas ^ 3);

B) in the indicated cases, examination of selected blood samples and
blood components for the presence of nucleic acids WNV.

Art. 7

Epidemiological investigation on suspicion of WNV infection rates

The person providing care ^ 1), which expressed suspected infection of WNV,
done by collecting biological material for laboratory certificate
etiological agent and ensure transportation of material removed to
National Reference Laboratory for arboviruses. National Reference Laboratory for arboviruses
reports results according to the agreement in writing or by phone
person providing care ^ 1) and the competent authority
protiepidemickému department of public health protection.

Art. 8

Anti-epidemic measures in the focus of infection WNV

First WNV disease reports under Article 5.

Second Ensuring sampling of biological material to verify the diagnosis and
transport to the National Reference Laboratory for arboviruses.

Third Infection control measures in the range of articles 2, 5, 6 and 7 were carried
the occurrence or on suspicion of all cases of WNV infection.
Appendix 16


The epidemiological vigilance infections enterohemoragickými
Escherichia coli (hereinafter "EHEC")

Art. 1

The clinical definition of the disease

First Clinical picture corresponding EHEC infection, it is diarrhea, often bloody
, and abdominal cramps, usually without fever or with only low
temperature (lower than 38 ° C). The disease can be complicated
hemolytic uremic syndrome (HUS diagnosis. D59.3). In the pathogenesis of EHEC infections
have a major role Shiga toxin (verotoxin): Shiga toxin 1
(STX1) and Shiga toxin 2 (Stx2).

Second The incubation period of the disease is 2-8 days. It depends on the size
infective dose which is very low (in strains O157: H7 indicates 10-100
bacteria), age, and susceptibility of the individual.
Risk groups affected are children under 5 years of age and persons older than 60 years.

Third The disease lasts for mild cases 5-6 days in the case of systemic complications
disease (HUS), a disease lasts up to several weeks.

Art. 2
Laboratory diagnosis


First Isolation and serotyping of Escherichia coli (slide agglutination
O, H antigens).

Second Detection of Shiga (verotoxin) (latex agglutination, ELISA, etc.).

Third Detection of genes encoding for the production of Shiga toxins 1 and 2 and their subtyping
.

Fourth Identification of other strains of EHEC virulence factors: Detection of genes for
adhesin intimin (EAE) and EHEC haemolysin (EHEC-hlyA) by PCR.

Fifth Confirmation O and H antigens genetic methods.

6th Method restriction analysis (PFGE) to the genetic findings
identical strains in epidemiological context.

7th Immunological determination of antibodies to lipopolysaccharide (LPS) in sera of patients
immunoblotting methods, passive hemagglutination, ELISA.

Examination is conducted from a stool sample at the outset of the disease, otherwise
probability of finding the causative agent in the material
rapidly declining. In case of failure of classical culture is selected
laboratories (National Reference Laboratory for Escherichia coli and Shigella
) should be used immunomagnetic separation method for the detection of EHEC strain
stool that for this investigation must be stored at || | temperature of minus 70 st. C.

Art. 3
Epidemiological criteria


Least one of these epidemiological links:

First Transmission from person to person

Second Exposure to a common source

Third Transmission from animals to humans

Fourth Exposure to contaminated food or drinking water

Art. 4

Case classification of diseases

A. Possible: Not applicable.

B. Probable: A case with clinical symptoms that has
epidemiological link or a laboratory confirmed isolate without clinical signs of disease
.

C. Confirmed: Clinically matching case that is laboratory confirmed
isolation of EHEC.

Art. 5

Data collection and reporting

The person providing care ^ 1), which diagnoses the disease EHEC, according
criteria in Articles 1-3, reported by public health authorities

Probable or confirmed case of EHEC disease or deaths from the disease
.

Art. 6

Epidemiological investigation on suspicion of EHEC incidence

First Caregivers ^ 1), which expressed suspicion of the disease EHEC
ensure collection of stools and its immediate transport to the investigating
microbiological laboratory. Microbiological laboratory will report the results
person providing péči1) and the relevant departments protiepidemickému
public health authorities. After the capture of suspected EHEC strains, especially
serogroup O157, O26, O111, O103 and O145, laboratory
immediately sends logs to the National Reference Laboratory for Escherichia coli and Shigella
National Public Health Institute. National Reference Laboratory
performs confirmation tribes detect Shiga toxins and other virulence factors
EHEC and reports the results back to the physician, the appropriate
protiepidemickému department of public health authorities and
microbiological laboratory.

Second Relevant anti-epidemic department of public health protection authority
ensure in all cases epidemiological investigation.
Investigation is focused mainly on detailed search for the source of infection, the route of disease transmission and
after other cases in focus on clinical disease and death
possible to verify the proper conduct sampling of biological material for laboratory
card etiology, or active
securing samples of biological material. This investigation must be launched immediately after the card
EHEC infection in the first case (index case).

Art. 7

Anti-epidemic measures in the focus of the disease EHEC

First EHEC disease reporting under Article 5.

Second Ensuring sampling of biological materials for laboratory examination.

Third Isolation of the patient, in more severe cases require hospitalization
according to another legal regulation 4).

Fourth Active search all contacts and microbiological analysis
their stool sample, a requirement serotyping of Escherichia coli. For
strains of serotype identical with germs providing examination
produce Shiga toxin.

Fifth Strict compliance with the sanitary measures in food production
in cooperation with the State Veterinary Administration, including compliance
production technology and good manufacturing practices.

6th Cooperation with the authorities of the State Veterinary Administration and State Agricultural and Food Inspection
tracing vehicle of infection.
Annex 17


The epidemiological vigilance viral hepatitis A (hereinafter referred to as "HAV")

Art. 1

The clinical definition of the disease

First Clinical picture corresponding to the VHA: the gradual development of symptoms, particularly
fatigue, abdominal pain, loss of appetite, intermittent nausea and vomiting
, along with symptoms of fever or jaundice, or elevated serum aminotransferase levels
. The incubation period of 15-50 days.

Second Period infectivity: in the stool, the virus is 1 to 2 weeks before the beginning
disease and 1-3 weeks after onset of the disease. The blood is
virus present in the second half of the incubation period and the beginning of the disease.

Art. 2
Laboratory diagnosis


At least one of the following criteria:

First Detection of specific IgM antibodies against HAV.

Second Detection of HAV nucleic acid in serum, plasma or faeces.

Third VHA antigen detection in stool.

Art. 3
Epidemiological criteria


Least one of these epidemiological links:

First Transmission from person to person

Second Exposure to a common source

Third Exposure to contaminated food or drinking water

Art. 4

Case classification of diseases

A. Possible: Not applicable.

B. Probable: Any person meeting the clinical criteria with
epidemiological context.

C. Confirmed: Any person meeting the clinical and laboratory criteria.

Art. 5

Data collection and reporting

The person providing care ^ 1), which diagnoses the disease VHA, reports
public health authorities confirmed case of the disease and deaths from this disease
.

Art. 6

Epidemiological investigation on suspicion of occurrence VHA

The person providing care ^ 1), which expressed suspicion of the disease VHA,
done by collecting biological material for laboratory license
disease and provide transport to the investigating laboratory. epidemiological

Investigation authority will ensure the protection of public health, in particular to determine
source of infection and transmission path.

Art. 7

Anti-epidemic measures in the outbreak of disease VHA

First Reports disease VHA under Article 5.

Second Ensuring the collection and transport of biological material of the patient and
contacts to verify the diagnosis of a competent laboratory. 3. Isolation
sick or suspect of illness, isolation wards by another legal
^ 2).

Fourth For those who have been in contact with patients, implementing medical supervision
period of 50 days from the last contact.

Fifth Receiving new people in communities preschool and school age
banned at the time of medical surveillance for occurrence of VHA
assessment by the locally competent public health protection authority.

6th Persons in contact with VHA performing activities epidemiologically
serious, are excluded from these activities
imposition of the increased medical surveillance for 50 days after the last contact with the patient.

7th Restrictions referred to in paragraphs 4, 5 and 6 shall not apply to persons who
demonstrated the presence of antibodies and simultaneously negativity on
specific IgM antibodies against the virus hepatitis and to persons duly proven
vaccinated against HAV.

8th The competent public health protection authority orders the extent and manner
immunoprophylaxis and in emergency situations, after approval by the chief hygienist
CR provides emergency vaccination in the community. Based
decisions locally competent public health protection authority of
medical surveillance or increased health supervision, ensure the person providing care
^ 1) for persons in direct contact with HAV vaccination against HAV.

9th For donors of blood and other biological material is governed by other laws
^ 5).
Annex 18


System of epidemiological vigilance of acute viral hepatitis B (hereinafter
"HBV")

Art. 1

The clinical definition of the disease

First Clinical picture corresponding to HBV: the gradual development of symptoms, particularly
fatigue, abdominal pain, joint pain, loss of appetite, intermittent nausea and vomiting
, along with symptoms of fever or jaundice, or
elevated levels of serum transaminases . The incubation period of 45 to 180
days.

Second Period of infectiousness: All HBsAg positive persons
are potentially infectious.

Art. 2
Laboratory diagnosis


Detection of specific IgM antigen
nucleocapsid (core) VHB.

Art. 3
Epidemiological criteria


Epidemiological link with transmission from human to human, especially
transmission by blood, sexual contact or vertical transmission.

Art. 4

Case classification of diseases

A. Possible: Not applicable.

B. Probable: Any person meeting the clinical criteria with
epidemiological context.

C. Confirmed: Any person meeting the clinical and laboratory criteria.

Art. 5

Data collection and reporting

The person providing care ^ 1), which diagnoses the disease acute hepatitis,
reported by public health authorities confirmed case of the disease and
deaths from the disease.

Art. 6

Epidemiological investigation on suspicion of the incidence of acute hepatitis

The person providing care ^ 1), which expressed suspicion of the disease
acute hepatitis, performs sampling of biological material for laboratory
card etiology and ensure their transport to the investigating laboratory.
Epidemiological investigation authority will ensure the protection of public health, especially
to identify the source of infection and transmission path.

Art. 7

Anti-epidemic measures in the focus of an acute HBV

First Reports disease acute hepatitis in accordance with Article 5.

Second Ensuring the collection and transport of biological material of the patient and
contacts to verify the diagnosis of a competent laboratory.

Third Isolation of sick or suspect the disease in isolation wards
according to another law ^ 2).

Fourth For individuals that have been in contact with the patient is carried
medical observation period of 180 days from the last contact.

Fifth For donors of blood and other biological material is governed by other laws
. ^ 5)

6th Restrictions referred to in paragraphs 3 and 4 shall not apply to persons with proven experiences we
HBV disease and those which have been
demonstrated the presence of antibodies to HBV surface antigen

Protection (minimum 10 IU / l).

7th Healthcare worker, who was exposed to patient blood
injury, or if there has been serious contamination of the skin and mucous membranes, and that
not currently vaccinated or were incompletely vaccinated or is known by him
inability making anti HBs , is administered 1 dose
specific hyperimmune globulin against hepatitis B in accordance with the summary of product characteristics
.

8th Caregivers ^ 1) to ensure examination of persons injured
a used needle, according to the table.
----------------------------------------------- - ------------------------------------------------- -
examined within 72 hours after injury 90 days after injury within 180 days after the injury
-------------------------- ---------------------- ---------------------------- -----------------------
hepatitis B Yes Yes Yes *
hepatitis C
Yes Yes Yes Yes Yes No HIV | || ------------------------------------------------ -------------------------------------------------- -

* U injured persons with proven protective titer of anti-HBs after immunization, or living
infection with other investigations of HBV markers quits.

When the negative outcome markers HBsAg, anti-HCV and anti HIV among
potential source, if known, the monitoring of injured persons
quits.

Part of the examination findings and subjective complaints and clinical
symptoms that may be associated with disease and viral hepatitis
laboratory tests aminotransferase activity. The event is always
recorded in the medical records of injured persons.
Annex 19


System of epidemiological vigilance hepatitis C virus (hereinafter "VHC")

Art. 1

The clinical definition of the disease

It is important for purposes of epidemiological vigilance.
Incubation period of 14-180 days.

Art. 2
Laboratory diagnosis


At least one of the following criteria:

First The presence of specific antibodies against the HCV virus confirmed
different test on a different principle of the test to detect antibodies.

Second Detection of viral nucleic acid of HCV in serum or plasma.

Third Antigen detection (core) of hepatitis C virus in serum or plasma.

Art. 3
Epidemiological criteria


Not applicable.

Art. 4

Case classification of diseases

A. Possible: Not applicable.

B. Probable: Not applicable.

C. Confirmed: Any person meeting the laboratory criteria.

Art. 5

Data collection and reporting

The person providing care ^ 1), which diagnoses the disease HCV, reported
public health authorities confirmed case of the disease and deaths from this disease
.

Art. 6

Epidemiological investigation on suspicion of the incidence of viral hepatitis C

The person providing care ^ 1), which expressed suspicion of the disease HCV
performs sampling of biological material for laboratory license
diseases and ensure their transport to the investigating laboratory.
Epidemiological investigation authority will ensure the protection of public health, especially
to identify the source of infection and transmission path.

Art. 7

Pandemic measures in the focus of HCV disease

First HCV disease reporting under Article 5.

Second Ensuring the collection and transport of biological material of the patient to verify the diagnosis
competent laboratory.

Third Patients diagnosed with acute HCV infection are isolated on
departments. Health care is also provided by the clinical picture of the patient
.

Fourth For those who have been in contact with patients, implementing medical supervision
of 150 days since last contact.

Fifth For donors of blood and other biological material is governed by other laws
^ 5).

6th Caregivers ^ 1) to ensure examination of persons injured
a used needle, according to the table.
----------------------------------------------- - ------------------------------------------------- -
examined within 72 hours after injury 90 days after injury within 180 days after the injury
-------------------------- ---------------------- ---------------------------- -----------------------
hepatitis B Yes Yes Yes *
hepatitis C
Yes Yes Yes Yes Yes No HIV | || ------------------------------------------------ -------------------------------------------------- -


* U injured persons with proven protective titer of anti-HBs after immunization, or living
infection with other investigations of HBV markers quits.

When the negative outcome markers HBsAg, anti-HCV and anti HIV among
potential source, if known, the monitoring of injured persons
quits.

Part of the examination findings and subjective complaints and clinical
symptoms that may be associated with disease and viral hepatitis
laboratory tests aminotransferase activity. The event is always
recorded in the medical records of injured persons.
Annex 20


System of epidemiological vigilance Chlamydia trachomatis infections

Art. 1

The clinical definition of the disease

First Clinical picture corresponding to chlamydial infection, other than
lymphogranuloma venereum (hereinafter "LGV") in children and adults -
inflammatory disease characterized by at least one of the following
symptoms: urethritis, epididymitis, acute salpingitis, acute | || endometritis, cervicitis, proctitis. The incubation period of 7-14 days, or longer
.

Second Clinical picture corresponding to chlamydial infection, other than LGV, u
newborn is characterized by at least one of the following symptoms:
conjunctivitis, pneumonia.

Third Clinical picture corresponding LGV:
inflammatory ulcerative infection characterized by at least one of the following symptoms: urethritis, genital ulcer
, inguinal lymphadenopathy, cervicitis, proctitis.

Fourth Period of infectivity can be very long and is not limited to
presence of clinical signs of infection. The sick can be a source of infection
thrives without subjective and objective difficulties.

Art. 2
Laboratory diagnosis


Chlamydia trachomatis, other than LGV, at least one of the following ways license
:

First Isolation of Chlamydia trachomatis in the sample from the urogenital tract,
anal region, or from the conjunctiva

Second Card Chlamydia trachomatis by direct immunofluorescence in a clinical specimen


Third Detection of Chlamydia trachomatis nucleic acid in a clinical specimen

Chlamydia trachomatis -LGV, at least one of the following means of compliance
:

First Isolation of Chlamydia trachomatis in the sample from the urogenital tract,
anal region, or from the conjunctiva

Second Detection of Chlamydia trachomatis nucleic acid in a clinical specimen

Third if the results referred to in point 1 or 2 while
serovar identification (genovaru) L1, L2 or L3

Art. 3
Epidemiological criteria


Epidemiological link - interpersonal transmission through sexual contact or vertical transmission
.

Art. 4

Case classification of diseases

A. Possible: Not applicable.

B. Probable: Clinically corresponding case with an epidemiological
context.

C. Confirmed: Clinically corresponding case laboratory confirmed.

Art. 5

Data collection and reporting

First Caregivers ^ 1), which diagnoses the disease caused by Chlamydia trachomatis
(other than LGV, LGV), reports the institution of public health protection
confirmed and probable cases of illness and death
this disease.

Second Cumulative data reported by the laboratory once a month
locally competent public health authorities according to the model:

A. the number of examinations performed by structured:

I. sex

Ii. age

Iii. diagnosis

Iv. expertise doctor

B. the number of positive findings structured by:

I. sex

Ii. age

Iii. diagnosis

Iv. expertise doctor

In. kind of biological material (cervical swab, urine, etc.)

Vi. Methods of Compliance (including name of manufacturer test)

Art. 6

Epidemiological investigation on suspicion of infection with Chlamydia trachomatis

The person providing care ^ 1), which expressed suspicion of infection Chlamydia trachomatis
ensure collection of biological material for laboratory
license disease, transport to the investigating
lab also conducts targeted tests on all contacts and
appropriate control after the treatment of patients diagnosed with infections.

Art. 7

Anti-epidemic measures in the focus of Chlamydia trachomatis

First Reports of disease caused by Chlamydia trachomatis under Article 5.

Second Anti-epidemic measures consist in proper implementation depistážního

Investigation and examination of all the contacts of the patient by another legal regulation
^ 6).

Third Up examination after 6 weeks after completion of therapy and
testing for other serious sexually transmitted diseases (syphilis, gonorrhea,
HIV / AIDS).

Fourth Examination of the patient for 3 months followed
examination and removal from the register, a negative control examination ^ 7).

Fifth For donors of reproductive cells is governed by a different legal
regulation 8).
Annex 21


System of epidemiological vigilance of invasive pneumococcal disease

Art. 1

The clinical definition of the disease

Clinical picture corresponding to invasive disease, it's meningitis, septicemia
, bacteremia, pneumonia. For pneumonia license is required originator
blood, serum or sectional material. The incubation period according to the clinical picture
1-4 days.

Art. 2
Laboratory diagnosis


First By culture of Streptococcus pneumoniae from clinical specimens,
which is normally sterile (cerebrospinal fluid, blood,
sectional material) with clinical manifestations in Article 1.

Second Bezkultivační antigen detection of Streptococcus pneumoniae latex agglutination
of clinical material, which is normally sterile
(cerebrospinal fluid, blood, sectional material) with clinical manifestations
under Article 1

Third Bezkultivační card Streptococcus pneumoniae DNA methods
molecular microbiology of clinical material, which is behind
normally sterile (cerebrospinal fluid, blood, sectional
material) with clinical manifestations in Article 1.

Due to the fact that the above clinical syndromes may be caused by a number
other etiological agents, the laboratory confirmation
etiology Streptococcus pneumoniae necessary. Isolates of Streptococcus pneumoniae
of invasive pneumococcal disease
sent to the microbiology laboratory National Reference Laboratory for
streptococci and enterococci National Public Health Institute in Prague.
National Reference Laboratory for antibiotics determines resistance to chemotherapeutic
. Sampling for culture examination is necessary before deploying
antibiotic therapy.

Art. 3
Epidemiological criteria


Not defined.

Art. 4

Case classification of diseases

A. Possible: Not applicable.

B. Probable: Not applicable.

C. Confirmed: a laboratory confirmed case of a positive result
culture diagnosis or detection of nucleic acids
Streptococcus pneumoniae or Streptococcus pneumoniae antigen detection of the above-mentioned
clinical material under Article 2

Art. 5

Data collection and reporting

The person providing care ^ 1), which diagnoses of invasive disease caused by Streptococcus pneumoniae
reported by public health authorities
confirmed case of the disease and deaths from the disease.

Art. 6

Epidemiological investigation on suspicion of invasive pneumococcal disease


The person providing care ^ 1), which expressed suspicion
invasive pneumococcal disease, performs sampling of biological material on
laboratory evidence of etiology and provide transport to the investigating
lab to find out whether he was sick vaccinated against pneumococcal and what
vaccine. Detailed epidemiological investigation to ensure protection authority
public health.

Art. 7

Pandemic measures in the focus of invasive pneumococcal disease


First Reports of invasive pneumococcal disease under Article 5.

Second Ensure collection of biological material from a patient and send
into the laboratory to laboratory.

Third Isolation of the patient. Isolation procedure governed by a different legal regulation
^ 4).
Annex 22


System of epidemiological vigilance campylobacteriosis

Art. 1

The clinical definition of the disease

First Clinical picture corresponding to campylobacteriosis, a fever,
diarrhea, abdominal pain. The incubation period of 1-10 days.

Second Infectiousness period for the duration of disease and a few days after
completion. After infection frequently occur carriage, which generally does not exceed
period of 6 weeks.

Art. 2
Laboratory diagnosis


First Laboratory diagnosis of campylobacteriosis is the direct detection

Campylobacter species in biological material by cultivation on selective diagnostic
soils and identification of phenotypic or genotypic
methods.

Second For epidemiological purposes, it is necessary to carry out the determination of generic
isolated campylobacter.

Biological materials are sent for examination usually includes a rectal swab or stool
less frequently sectional material, joint puncture, blood and other
. Sampling is done swabs, rectal swab using a transport medium
.

Art. 3
Epidemiological criteria


Least one of these epidemiological links:

First Transmission from person to person

Second Transmission from animals to humans

Third Exposure to a common source

Fourth Exposure to contaminated food or drinking water

Art. 4

Case classification of diseases

A. Possible: Not applicable.

B. Probable:

First A case that meets the clinical case definition and has
epidemiological link to a confirmed case.

Second Laboratory-confirmed case with unknown clinical criteria.

Third A laboratory confirmed case without clinical criteria

C. Confirmed: A case that meets the clinical case definition and is laboratory confirmed
.

Art. 5

Data collection and reporting

The person providing care ^ 1), which diagnoses the disease
campylobacteriosis, reported by public health authorities
probable or confirmed case of illness or death from this disease.

Art. 6

Epidemiological investigation on suspicion of occurrence of campylobacteriosis

First Caregivers ^ 1), which expressed suspicion of the disease
campylobacteriosis, done by collecting biological material for examination and culture
material taken immediately sends
microbiological laboratory. Microbiological laboratory reports results according to the agreement
telephone or in writing to the person providing the care ^ 1) and the relevant departments
protiepidemickému public health authorities.

Second Relevant anti-epidemic department of public health protection authority shall ensure that an epidemiological investigation
u
confirmed cases of campylobacter. Investigation lies in the active search for contacts, it is
preschool children and persons performing activities epidemiologically
serious in timely implementation of biologic material on
laboratory evidence of the causative agent and determination of the source of infection and transmission routes
.

Third In cases of suspected mass disorders in cases with atypical
course or deaths due to campylobacteriosis ensure protection authorities
Public Health in cooperation with the microbiological laboratory strains of campylobacter
sending a further determination of the Department laboratories hygiene and nutrition
food safety, the Public health Institute in Brno.

Art. 7

Anti-epidemic measures in the outbreak of campylobacteriosis

First Reports disease campylobacteriosis under Article 5.

Second Ensuring sampling of biological materials for laboratory examination.

Third Isolation of the patient, in severe cases hospitalization by another
legal regulation 4).

Fourth Active search for people who consumed diet and a listed
search contacts for preschool children and persons performing activities epidemiologically serious
where by microbiological examination
rectal swab or stool.

Fifth Medical supervision for contacts for 5 days from the occurrence of the last case
illness in children's preschool establishments.

6th Search and subsequent disqualifications possibly finish
working conditions for persons performing activities epidemiologically serious that
exclude Campylobacter or who experienced disease
person living in the household, until three consecutive cultivation || | negative results of stool examination by assessing local
competent authority to protect public health.

7th Children from families of similar institutions and other collectives, where the disease occurred
campylobacter can lead to the team, they are in good clinical condition
, have diarrhea, and after assessing the conditions of equipment
locally competent authority to protect public health.

8th The collectives and households carry a focal
continuous disinfection, hand disinfection, sanitary facilities, objects, areas,

Dishes and more.

9th In households with incidence of campylobacter and breeding of domestic
animals, especially dogs, cats and exotic birds can possibly make
sampling stool in animals.

10th Strict compliance with the sanitary measures in food production,
in the preparation and handling of food, compliance with good manufacturing and hygienic practices
.

11th Cooperation with the authorities of the State Veterinary Administration and State Agricultural and Food Inspection
tracing vehicle of infection.
Appendix 23


System of epidemiological vigilance of Lyme disease

Art. 1

The clinical definition of the disease

Clinical diagnosis of Lyme disease is determined on the basis of criteria
three phases of illness:

First Early localized borreliosis is characterized by skin lesions
marked as erythema migrans. The incubation period of 3-32 days, the early stage
may be inapparent.

Second Early disseminated borreliosis is characterized by the presence
agent in cutaneous tissue (borrelian lymphocytes), musculoskeletal, nervous and cardiac
(myalgia, arthralgia, recurrent arthritis, disability
N cranial nerves II, III, VI, VII, VIII, meningomyeloradikuloneuritidy
"Garin-Bujadoux- Bannwarth syndrome", aseptic meningitis, carditis
).

Third Late chronic borreliosis, which arises after months to years after
infection is characterized by nervous system involvement
(chronic encephalomyelopathy, chronic polyneuritis, depression and other psychic manifestations
), joints (Lyme arthritis) and skin (
inflammatory or atrophic akrodermatitida).

Art. 2
Laboratory diagnosis


First Demonstration of IgM and IgG antibodies in serum borreliím
or in the cerebrospinal fluid and synovial fluid by enzymatic
immunoassay (ELISA) in clinically questionable cases
source confirmed by immunoblot (Western blot).

Second Culture of the Borrelia burgdorferi sensu lato from clinical
material.

Third Bezkultivační antigen detection or detection of genomic and plasmid
nucleic acid (DNA) borrelia, optionally in combination with a direct
microscopic identification.

Start treatment in the acute phase under Article 1 paragraph 1 shall not pass
antibodies needed.

Art. 3
Epidemiological criteria


Least one of the following epidemiological links
during the last 4 weeks before the appearance of the first symptoms:

First Confirmed tick bite.

Second Staying in the incidence of ticks.

Third Risk handling tick, tick removal especially when
there is direct contact of the skin of the patient.

Art. 4

Case classification of diseases

A. Possible: A case that meets the clinical definition of the disease.

B. Probable: A case that meets the definition of clinical and epidemiological
in connection with a confirmed tick bite.

C. Confirmed: A case that meets the definition of clinical and
been confirmed by laboratory results.

Art. 5

Data collection and reporting

The person providing care ^ 1), which diagnoses of Lyme borreliosis
, according to the criteria in Articles 1-3, reports the body for protection of public health
probable and confirmed case of illness or death
this disease.

Art. 6

Epidemiological investigation on suspicion of the incidence of Lyme disease

First Caregivers ^ 1), which expressed suspicion of the disease
Lyme borreliosis, ensuring sampling of biological material on
laboratory evidence of etiology and transport it to the investigating
lab.

Second Public health authorities to ensure the epidemiological investigation, during which
outside standard fact finding records
clinical form of the disease, possible death and searches for the likely site of infection.

Art. 7

Pandemic measures against the spread of Lyme disease

First Reports of Lyme borreliosis in accordance with Article 5.

Second Anti-epidemic department of public health protection authority in their jurisdiction
recorded outbreak of Lyme disease and recommended
within their adherence to preventive measures to reduce the risk
ticks.

Third People with active disease borreliosis are deleted from donation

Blood and its components and the donation of tissues and cells for a period of 6 months after
cure. The exclusion of people with chronic diseases the medical practitioner.

Fourth State Health Institute in cooperation with the Czech Hydrometeorological Institute during the season
performs prediction of tick activity, which is like
indicative figure for people placed on the website of the Ministry
Health, the Public Health Institute and the bodies of public health
.
Annex 24


System of epidemiological vigilance shingles

Art. 1

The clinical definition of the disease

First The clinical picture is characterized shingles unilateral
sowing maculopapular rash in the range 1-3 dermatomes,
most often in the lumbar or thoracic region.
Sowing can prevent severe pain at the site of the future planting.
The most common complication is post-herpetic neuralgia disease, particularly in patients over 50 years
. Other possible complications include neurological (cerebellitis,
meningoencephalitis, myelitis, intracranial vasculitis) or ocular
(keratitis, iridocyclitis, retinitis) or bacterial superinfection
skin and soft tissues. In immunocompromised individuals threatening systemic
disorder (generalized form). The incubation period of 10-21 days.

Second Infectiousness period begins sowing rash and ends when they are already
all efflorescence stage crusts. Infectivity is localized at
mold 5 times lower than with varicella.
Infectious vesicular fluid in generalized form and secretions from the upper respiratory tract.

Art. 2
Laboratory diagnosis


Least one of the following criteria:

First Detection of nucleic acid varicella zoster virus in a clinical specimen
(peripheral blood, vesicular fluid, cerebrospinal fluid, smear from a lesion)

Second Isolation of varicella zoster virus in tissue cultures from swabs or vesicular fluid


Third Detection of viral antigen by direct immunofluorescence smear of efflorescence


Fourth Virus detection by electron microscopy in the clinical sample

Fifth Rise specific antibodies against varicella zoster virus.
Presence of IgM antibodies may be biased to their occurrence during
subclinical reactivation of the virus, as well as cross-reactivity with IgM
antibodies against other herpes viruses, particularly herpes simplex virus
. Therefore, their capture isolated from one sample to be regarded as insufficient
license. Cases must be verified
significant increase in levels of total or IgG antibodies.
Correct interpretation of the results of serological tests must be taken into account clinical,
laboratory and epidemiological data.

Art. 3
Epidemiological criteria


The disease occurs only in people who suffered from chickenpox (also
subclinical) or have been vaccinated with a live vaccine against chickenpox
smallpox.

Art. 4

Case classification of diseases

A. Possible: A case of atypical clinical course and repeated strip
herpes without laboratory tests.

B. Probable: A case that meets the clinical definition of the disease.

C. Confirmed: A case that meets the definition of clinical and
was confirmed by laboratory results.

Art. 5

Data collection and reporting

The person providing care ^ 1), which diagnoses diseases belt
haze, reported by public health authorities
probable and confirmed cases of the disease, complications and deaths from the disease.

Art. 6

Epidemiological investigation on suspicion of occurrence of herpes zoster

The person providing care ^ 1), which expressed suspicion of the disease
shingles, in its sole discretion in clinically doubtful cases
performs sampling of biological material for laboratory license
etiology and provide transport to the investigating laboratory.

Art. 7

Pandemic measures in the focus of shingles

First Reports disease shingles under Article 5.

Second Ensuring sampling of biological material from a patient to verify
diagnosis in clinically doubtful cases and ensuring
transport of biological material in the laboratory.

Third Patient isolation lasts until all efflorescence in
stage crusts. Isolation procedure regulated by other legislation ^ 4).

Fourth Active search for the source of infection and contacts is performed.


Fifth Epidemiological investigation of the outbreak of the disease is not performed. The person providing care
^ 1), which expressed suspicion of the disease belt
hazing, paying special attention to pregnant women and immunosuppressed persons,
by far not had chickenpox or have not been properly vaccinated.

6th For administration hyperimmune human immunoglobulin is necessary to assess the severity
exposure. Generalized shingles is as contagious as chickenpox
and should therefore be hyperimmune globulin human
filed within 72 hours of contact with the infection in pregnant or persons
severely immunosuppressed, which in the past not had chickenpox or || | were vaccinated with two doses of vaccine. Only if Omitted
interval of 72 hours of contact with the disease, the alternative is
administration of therapeutic doses of antiviral drugs in the seventh day of contact with
infection.

7th Postexposure vaccination is possible in susceptible individuals to infection
chickenpox, for which there has not been 3 days after contact with sick
.

8th For susceptible persons who were in contact with the disease, has
medical supervision, if indicated, will last for a maximum incubation period, it is
21 days. If such a person has filed a human hyperimmune globulin
period is extended to 40 days.

9th Children who are susceptible to infection and have been in contact with the belt
herpes, are due to the low infectivity accepted into collective
device without restrictions.
Appendix 25


System of epidemiological vigilance rotavirus infections

Art. 1

The clinical definition of the disease

First Clinical picture corresponding to acute gastroenteritis, it is vomiting,
diarrhea, fever. Vomiting disease starts suddenly with high frequency.
Within 24 hours added watery diarrhea with high volume and frequency of stools
produced. Manifest disease is usually accompanied
fever, sometimes only a slight rise in temperature.
Most serious course of the disease is in children under 5 years and persons aged 65 years
with rapid dehydration and hypernatremia. Incubation time 24 to 72 hours.

Second Period of communicability can be long, especially in immunocompromised individuals
.

Art. 2
Laboratory diagnosis


First Standard laboratory test for diagnosis of rotavirus infection is
card antigen (s) of rotaviruses. Currently the most commonly used
immunochromatographic rapid tests, latex agglutination and ELISA
. The laboratory testing takes native stool or rectal swab
. The highest detection rate in the first 3 days of the disease.

Second Electron card originator.

Third Detection of nucleic acid.

Fourth Detection of specific antibody response against rotavirus infections in
persons who are not within the preceding eight weeks vaccinated. To
serological examination shall be collected two blood samples at 2-week intervals
. One sample was taken as soon as possible in the acute stage.
Prerequisite for serological diagnosis is currently testing the first and second
serum sample. Confirmation of ongoing disease is proven
significant increase in antibody levels or seroconversion from negativity to positivity
. Any level of antibodies in a single sample is not
evidence of acute ongoing disease.

Due to the fact that the aforementioned clinical symptoms may be caused by a number
other etiological agents, the laboratory confirmation
rotaviruses necessary.

Art. 3
Epidemiological criteria


None.

Art. 4

Case classification of diseases

A. Possible: A case that meets the clinical case definition.

B. Probable: A case that meets the clinical case definition and has
epidemiological link to a confirmed case.

C. Confirmed: A case that meets the definition of clinical and
was confirmed by a laboratory examination.

Art. 5

Data collection and reporting

The person providing care ^ 1), which diagnoses the illness caused by rotavirus
, reported by public health authorities
probable or confirmed case of illness or death from this disease.

Art. 6

Epidemiological investigation on suspicion of incidence of disease caused by rotavirus


The person providing care ^ 1), which expressed suspicion of the disease caused by rotavirus
ensure collection of native stool or swab

Rectum and ensure the transport of biological material immediately into
investigating laboratory. Epidemiological investigation authority will ensure the protection of public health
.

Art. 7

Anti-epidemic measures in the outbreak of a disease caused by rotavirus

First Public Health Authority carried out on all notified cases
epidemiological investigation into the outbreak quest for the source of the outbreak and
other contacts, including verification of the data, whether the sick person has been in the past
vaccinated against rotavirus infections.

Second Isolation procedure regulated by other legislation ^ 4).

Third Child younger than 5 years after suffering a laboratory-proven
disease caused by rotavirus can be taken to the nursery, kindergarten
school facilities for institutional care or protective custody,
special children's facilities, social care facilities and similar || | equipment (hereinafter the "collective facilities"), provided that no
clinical symptoms of rotavirus infection, but no sooner than 10 days from the onset of the disease
.

Fourth The person performing activities epidemiologically serious after suffering
laboratory-proven disease caused by rotavirus can perform these activities
assuming no clinical symptoms of rotavirus infection
earliest, 10 days after the onset of the disease.

Fifth Medical supervision for a period of 3 days from the last contact with the patient at
children under 5 years of age attending collective facilities and instruction
their legal representatives to contact their physician in the development
symptoms, including elevated temperature.

6th Increased medical supervision for a period of three days from the last contact with the sick
natural persons performing activities epidemiologically
serious.

7th Rotavirus infection during hospital or suspected its presence
caregivers shall ensure the implementation of anti-epidemic measures
.
Annex 26


System of epidemiological vigilance salmonellosis

Art. 1

The clinical definition of the disease

First Clinical picture corresponding salmonellosis, a fever, diarrhea,
abdominal pain, nausea and sometimes vomiting.
Originator disease can also cause extra-intestinal infections (localization of the infection outside
intestinal tract). The incubation period of 6-72 hours.

Second Infectivity lasts throughout the disease, which is extremely variable, from
few days to several weeks. Chronic carriage
lasting longer than one year are rare. Antibiotics do not affect the elimination of salmonella.

Art. 2
Laboratory diagnosis


First Laboratory diagnosis of salmonellosis based on direct detection of Salmonella in biological samples
cultivation on selective diagnostic soils and
identify phenotypic or genotypic methods.

Second For epidemiological purposes, it is necessary serotyping.

Third For significant serotypes implementing phage typing or other
level analysis genotype.

Fourth Indirect diagnosis provides antibodies against O, H and optionally VI
antigens.

Biological material for examination according to the type of disease: rectal swabs, stool
serum, urine, bile, pus, joint puncture, sectional
material and more.

Art. 3
Epidemiological criteria


Least one of these epidemiological links:

First Transmission from person to person

Second Exposure to a common source

Third Transmission from animals to humans

Fourth Exposure to contaminated food or drinking water

Art. 4

Case classification of diseases

A. Possible: Not applicable.

B. Probable: A case that meets the clinical case definition and has
epidemiological link or a laboratory confirmed isolate without clinical information
.

C. Confirmed: A case that meets the clinical case definition and is laboratory confirmed
.

Art. 5

Data collection and reporting

The person providing care ^ 1), which diagnoses the illness salmonellosis,
according to the criteria in Articles 1-3, reported by public health authorities
probable and confirmed case of illness or deaths from the disease
.

Art. 6

Epidemiological investigation on suspicion of presence of Salmonella

First Caregivers ^ 1), which expressed suspicion of the disease
salmonellosis, performs sampling of biological material on culture

Examination and sends the material taken immediately
microbiological laboratory. Microbiological laboratory reports results according to the agreement
telephone or in writing to the person providing the care ^ 1) and the relevant departments
protiepidemickému public health authorities.

Second Relevant anti-epidemic department of public health protection authority
ensure epidemiological investigation of all confirmed cases
and in the case of epidemic occurrence also in all cases of suspected
illness salmonellosis. Investigation is in the early design
sampling of biological material for laboratory evidence of etiology, active
search contacts, which are also carried
microbiological examination and determine the source of infection and transmission routes.

Art. 7

Anti-epidemic measures in the outbreak of salmonella

First Reports disease salmonellosis in accordance with Article 5.

Second Ensuring sampling of biological materials for laboratory examination.

Third Isolation procedure regulated by other legislation ^ 4).

Fourth Active search for individuals who consumed know of a diet
particularly preschool children and persons performing activities epidemiologically significant
where by microbiological examination
rectal swab. Circuit investigated persons determined locally competent authority
protection of public health.

Fifth Medical supervision for 4 days from the occurrence of the last case
illness in children's preschool establishments.

6th Search and subsequent disqualifications possibly finish
working conditions for persons performing activities epidemiologically serious, which exclude
salmonella or who experienced disease
person living in the household, until three consecutive cultivation || | negative results of stool examination.

7th Baby after suffering laboratory confirmation of the disease salmonellosis
is possible to adopt a collective device to one negative
culture stool, or if the child is in good clinical condition
based on the assessment of the locally competent authority to protect public
health.

8th Children from families of similar institutions and other collectives, where the disease occurred
salmonellosis may occur into the team if they are in good clinical condition
, have diarrhea, and after assessing the conditions of facilities locally
competent authority to protect public health.

9th The collectives and households carry a focal
continuous disinfection, hand disinfection, sanitary facilities, objects, surfaces and utensils
further.

10th Strict compliance with the sanitary measures in food production, especially
processing, storage and transportation of hazardous materials and
food production technology and adherence to good manufacturing practices.

11th Cooperation with the authorities of the State Veterinary Administration and State Agricultural and Food Inspection
tracing vehicle of infection.
Annex 27


System of epidemiological vigilance acquired or congenital syphilis

Art. 1

The clinical definition of the disease

First The resulting primary syphilis - that is ulcerative disease
characterized by the presence of one, exceptionally few, usually painless
, erosive to ulcerative lesions (šankrů) in the genital, anal or perineal
area, mouth, pharyngeal mucosa or | || elsewhere extragenitally. The incubation period of 10 days to 3 months
.

Second The resulting secondary syphilis - a person with at least one of these symptoms
: diffuse maculopapular rash involving the palms and often
slab generalized lymphadenopathy, condyloma latum, rash, alopecia, diffuse
.

Third The resulting early latent syphilis - a person with symptoms of primary or secondary syphilis
history in the preceding 24 months
meeting the laboratory criteria (specific tests).

Fourth Obtained late latent syphilis over 24 months -
person meeting laboratory criteria (specific tests).

Fifth Congenital syphilis early - child under 2 years of age meets at least one of
following symptoms: hepatosplenomegaly, mucocutaneous lesions
condyloma latum, persistent rhinitis, jaundice, pseudoparalýza
due to periostitis and osteochondritis, affliction of the central nervous
system, anemia, nephrotic syndrome, malnutrition.

6th Late congenital syphilis - a person over 2 years of age with clinical manifestations

Corresponding late congenital syphilis and meeting the laboratory criteria
(specific tests).

7th Infectiousness period is limited to the presence of clinical manifestations in
contact time or in the previous 24 months (or blood transfer from mother to fetus
).

Art. 2
Laboratory diagnosis


A. Confirmed case - at least one of the following findings:

First Detection of Treponema pallidum subspecies pallidum microscopic examination
dark field in the exudate of the lesions in the tissue, umbilical cord, placenta
or runny nose

Second Detection of Treponema pallidum subspecies pallidum
direct immunofluorescence in the exudate of the lesions in the tissue, umbilical cord, placenta
or runny nose

Third PCR Detection of Treponema pallidum subspecies pallidum in the exudate of the lesions
tissue, umbilical cord, placenta, or rhinorrhea

Fourth Detection of specific antibodies against Treponema pallidum subspecies pallidum
using the screening test (eg. TPHA, TP-PA, EIA, etc.) And
while detection of specific antibodies against Treponema pallidum subspecies pallidum
in class IgM

Fifth For congenital syphilis detection of specific IgM antibodies against Treponema pallidum subspecies
pallidum and simultaneously detect non-specific antibodies in
netreponemovém test (eg. VDRL, RPR)

B. Probable case - at least one of the following findings:

First Detection of specific antibodies against Treponema pallidum subspecies pallidum
using the screening test (eg. TPHA, TP-PA, EIA etc.).
And also confirmation of specific antibodies against Treponema pallidum subspecies pallidum
IgG methodically independent test ( FTA-ABS
IgG western blot IgG)

Second For congenital syphilis detection of non-specific antibodies against Treponema pallidum subspecies pallidum
in netreponemovém test (eg. VDRL, RPR) in the liquor


Third In congenital syphilis detection of specific antibodies against Treponema pallidum subspecies
pallium by a screening assay (e.g. TPHA,
TP-PA, EIA etc.). As well as confirmation of specific antibodies against Treponema pallidum subspecies
pallidum IgG methodically
independent test (FTA-ABS IgG western blot IgG) maternal

Fourth For congenital syphilis detection of non-specific antibodies against Treponema pallidum subspecies pallidum
in netreponemovém test (eg. VDRL, RPR)
in four times higher titer than in the mother

Art. 3
Epidemiological criteria


Epidemiological link - interpersonal transmission through sexual contact or vertical transmission
.

Art. 4

Case classification of diseases

A. Possible: Not applicable.

B. Probable: Clinically corresponding case with an epidemiological
context and laboratory tests corresponding
probable case.

C. Confirmed: Clinically corresponding case laboratory confirmed.

Art. 5

Data collection and reporting

The person providing care ^ 1), which diagnoses the disease
acquired or congenital syphilis, reported by public health authorities confirmed a
probable cause of illness and death from the disease by
criteria in Article 1 to 3

Art. 6

Epidemiological investigation on suspicion of syphilis incidence

First Caregivers who voiced suspicion of infection
Treponema pallidum subspecies pallidum, ensure the collection of biological material for laboratory
card etiology and its transport to the laboratory
investigating.

Second Dermatovenerologického clinician working with depistážní
service, the place of residence of the patient with confirmed infections carried
targeted examination of all relevant contacts and the associated control after
treatment of patients with diagnosed infection.

Art. 7


Measures Pandemic
First Reports diseases caused by Treponema pallidum subspecies pallidum
according článkku fifth

Second Anti-epidemic measures consist in proper implementation depistážního
investigation and examination of all relevant contacts of the patient by another
legal regulation 6).

Third For syphilis I. and II. stage must be compulsory isolation and treatment at
venereological departments and individuals are obliged to undergo treatment
according to another legal regulation 2).

Fourth For donors of blood and other biological material is governed by another law
^ 5).
Annex 28


System of epidemiological vigilance encephalitis

Art. 1


The clinical definition of the disease

The clinical picture of the disease can occur in two phases.

First The first symptoms usually appear after an incubation period of 7-14 days (
3 to 28 days) after exposure, which is conditioned by an infected tick by tick,
or staying in the incidence of ticks, or handling hazardous
tick, or consumption of unpasteurized milk, cheese, yogurt or
other products, particularly from goat and sheep's milk, during the last 4
weeks before the onset of symptoms. In the first period
lasting 2-7 days chřipkovitý disease has character, it is increased
temperature, fatigue, weakness, joint and muscle pain, headache - called.
Abortive form - with negative cerebrospinal fluid findings. The first phase may
sometimes miss.

Second After several days the first symptoms subsided (approximately 4 to 10 days)
may be the second stage of the disease at which it is hit
central nervous system. According to the severity and clinical goes in this second phase of
form meningitickou (meningitis) or
meningoencefalitickou (with disabilities gray and white matter of the brain) or
meningo-encefalomyelitickou (s leading disability horns of the spinal cord) or
form of bulbocervikální (disabled segments of the cervical spine and spinal cord extended
).

Art. 2
Laboratory diagnosis


First Determination of IgM antibodies in serum or CSF by ELISA or NIF
(by indirect immunofluorescence).

Second Proof of seroconversion or a significant rise in antibody levels
class IgG or total antibodies using ELISA, or NIF KFR.

Patients recently vaccinated against tick-borne encephalitis, yellow fever
, Japanese encephalitis, and people who have returned from endemic areas
these viruses, dengue fever and West Nile virus, it is necessary
serological results confirm the virus neutralization assay.

Art. 3
Epidemiological criteria


With regard to case classification of diseases in Article 4 can not be
epidemiological criteria apply.

Art. 4

Case classification of diseases

A. Possible: Not applicable.

B. Probable: Not applicable.

C. Confirmed: A case that meets the clinical case definition and is laboratory confirmed
.

Art. 5

Data collection and reporting

The person providing care ^ 1), which diagnoses the disease tick-borne encephalitis
, reported by public health authorities confirmed case
disease or die from the disease according to the criteria of Articles 1
third

Art. 6

Epidemiological investigation on suspicion of the incidence of tick-borne encephalitis

The person providing care ^ 1), which expressed suspicion of tick-borne encephalitis
, done by collecting biological material for laboratory
card etiology and provide transport to the investigating laboratory.
Investigating laboratory reports results according to the agreement in writing or by phone
person providing care ^ 1) and the relevant protiepidemickému
department of public health authorities. Antiepidemic department
public health protection authority shall ensure that an epidemiological investigation, during which, among other things
find out facts concerning vaccination records and
clinical form of the disease and eventually die from the disease.
It identifies circumstances tick infestation sick, especially if possible
date akvirace and most exact determination of the place where the akviraci occurred.
It also investigates whether the patient did not consume raw milk or heat
products from it.

Art. 7


Measures Pandemic
First Anti-epidemic department of public health protection authority in their jurisdiction
recorded outbreaks of encephalitis and
encourages their visitors
adherence to preventive measures to reduce the risk of ticks.

Second Public Health Authority in cooperation with medical institutions and
State Institute of Health provides health awareness events
increasing awareness of the population of non-specific preventive measures, especially
about the possibility of vaccination against tick-borne encephalitis, especially when repeated or prolonged
stay in the foci of TBE.
Participates in national events mapping the incidence of ticks
natural environment and their occurence infectious agents that are transmitted.

Third In case of a possible foodborne transmission protection authority

Ensure public health and anti-epidemic measures to ban the consumption
suspected vehicles as well as unpasteurised dairy products
this milk will actively search for all exposed persons and ensure their
clinical and serological tests for tick-borne | || encephalitis.

Fourth In collaboration with veterinarians and National Reference Laboratory for arboviruses
Health Institute in Ostrava ensure investigation of suspected
source animals and their milk for the presence of virus, tick-borne encephalitis and their
serum for antibodies against tick-borne encephalitis
examination and possible reservoir animals.

Fifth State Health Institute in Prague in cooperation with the Czech Hydrometeorological Institute
done during the season weather activities
ticks, that is, as an indication for the citizens placed on the web site
Ministry of Health, the Public Health Institute and
protection authorities public health.
Annex 29


System of epidemiological vigilance chickenpox

Art. 1

The clinical definition of the disease

First The clinical picture is characterized by progressive sowing maculopapular rash pruritic
, increased temperature or fever. Sowing
begins on the torso and head, including the hairy part, gradually spreads to the limbs
. Sowing usually takes place in several waves and therefore tend
parallel to present all the developmental stages of rash (macula, papule, vesicle
, pustule, crust). We have more severe disease in adults
(prolonged fever, massive planting of lesions). Complications of the disease
risk, particularly in children under 1 year of age, adults over 20 years of age and pregnant
individuals and immunosuppressed.

Neurologic complications (cerebellitis, encephalitis, myelitis) or pulmonary
(varicellová pneumonia, secondary bacterial pneumonia)
or bacterial superinfection of skin and soft tissue infections and bleeding disorders.
Systemic disease risk in people and immunocompromised neonates whose mothers
occurred sowing varicella 5 days before and 2 days after birth
. Varicella zoster virus is considered to be teratogenic and
primary infection during pregnancy before the twenty-eighth week threatens the emergence of so-called.
Congenital varicella syndrome.

Incubation period of 10-21 days.

Second Infectiousness period begins two days before sowing rash and ends
if they are already at the stage of efflorescence all crusts.

Art. 2
Laboratory diagnosis


At least one of the following criteria:

First Detection of nucleic acid varicella zoster virus in a clinical specimen
(peripheral blood, vesicular fluid, cerebrospinal fluid)

Second Isolation of varicella zoster virus in tissue cultures

Third Detection of viral antigen by direct immunofluorescence smear of efflorescence


Fourth Virus detection by electron microscopy in the clinical sample

Fifth Rise specific antibodies against varicella zoster virus.
Presence of IgM antibodies may be biased to their occurrence during
reactivation of the virus, as well as cross-reactivity with IgM antibodies
other herpes viruses, particularly herpes simplex virus. That is why
capture their isolated from one sample to be regarded as insufficient
license. Cases must be verified by a significant increase
levels of total or IgG antibodies. Correct interpretation of results
serological tests must be taken into account clinical, laboratory and epidemiological data
.

Art. 3
Epidemiological criteria


Epidemiological link - interpersonal transmission of the disease.
Disease is transmitted by direct contact with a sick person, a person with exceptional
vaccinated. The virus is contained in vesicular fluid efflorescence during
chickenpox and shingles, and secretions from the upper respiratory tract
. It applies indirect transfer
objects contaminated with secretions from the respiratory tract or skin lesions containing exceptionally
is transferred and placenta.

Art. 4

Case classification of diseases

A. Possible: A case with typical clinical course
without laboratory testing.

B. Probable: A case that meets the clinical definition of the disease and epidemiological
in connection with other cases.

C. Confirmed: A case that meets the clinical case definition and is laboratory confirmed
.

Art. 5

Data collection and reporting


The person providing care ^ 1), which diagnoses the disease varicella
chickenpox, reports the public health body disease
hospitalization, complications and deaths from the disease and an indication of
immunization.

Art. 6

Epidemiological investigation on suspicion of occurrence of chickenpox

The person providing care ^ 1), which expressed suspicion of the disease
chickenpox, in its sole discretion clinically
contentious cases, performs sampling of biological material for laboratory license
etiology and provide transport to the investigating laboratory .

Art. 7

Anti-epidemic measures in the outbreak of chickenpox

First Reports disease chickenpox pursuant to Article 5.

Second Ensuring sampling of biological material from a patient to verify
diagnosis in clinically doubtful cases and ensuring
transport of biological material in the laboratory.

Third Patient isolation lasts until all efflorescence in
stage crusts. Isolation procedure regulated by other legislation ^ 4).

Fourth Active search for contacts and sources of infection is very uncommon.

Fifth Epidemiological investigation of the focus of infection is very uncommon. The person providing care
^ 1), which expressed suspicion of varicella disease
pox, paying special attention to those pregnant women and immunosuppressed
which hitherto not had chickenpox or been vaccinated
properly.

6th Submission of hyperimmune human immunoglobulin within 72 hours of contact persons
infection in pregnant or severely immunosuppressed, which in the past
nešotvice not had chickenpox or have not been properly vaccinated. If
Omitted interval is 72 hours of contact with the disease alternative
administration is therapeutic doses of antiviral drugs in the seventh day of
contact with the infection. Furthermore hyperimmune human immunoglobulin serves
newborns whose mothers took place at sowing chickenpox
5 days before and 2 days after birth and nedonošencům, born before the twenty-eighth
weeks gestation who were in contact with chicken pox .

7th Postexposure vaccination is possible in susceptible individuals to infection
chickenpox, for which there has not been 3 days after contact with sick
.

8th In susceptible persons who have been in contact with the disease has
medical supervision if indicated, last for a maximum incubation time, it is
21 days. If such a person was filed
hyperimmune human immunoglobulin period is extended to 40 days.
Annex 30


System of epidemiological vigilance hepatitis E (hereinafter "VHE")

Art. 1

The clinical definition of the disease

First The clinical picture is similar to viral hepatitis A;
gradual development of symptoms, especially fatigue, abdominal pain, loss of appetite,
occasional nausea and vomiting, jaundice, elevated aminotransferases
, dark urine, pain in the joints. Infections tend to have higher mortality
pregnant, especially in the third trimester of pregnancy.
The incubation period is 15-60 days.

Second Period of communicability is unknown. The virus is detectable in the stool already
the end of the incubation period and virus excretion lasts for 2 to 3 weeks.

Art. 2
Laboratory diagnosis


At least one of the following criteria:

First Detection of specific IgM VHE.

Second Detection of viral RNA VHE in stool or blood.

Art. 3
Epidemiological criteria


Least one of these epidemiological links:

First Transmission from person to person.

Second Exposure to a common source.

Third Exposure to contaminated food or drinking water.

Fourth Staying in an area where the VHE, with a predominance interhumánního transmission.

Art. 4

Case classification of diseases

A. Possible: Not applicable.

B. Probable: Any person meeting the clinical criteria with
epidemiological context.

C. Confirmed: Any person meeting the clinical and laboratory criteria.

Art. 5

Data collection and reporting

The person providing care ^ 1), which diagnoses the disease VHE, reports
public health authorities confirmed case of the disease and deaths from this disease
including suspicion of the disease.

Art. 6

Epidemiological investigation on suspicion of occurrence of VHE

The person providing care ^ 1), which expressed suspicion of the disease VHE,

Performs sampling of biological material for laboratory license
diseases and ensure their transport to the investigating laboratory.
Epidemiological investigation authority will ensure the protection of public health, especially
to identify the source of infection and transmission path.

Art. 7

Anti-epidemic measures in the outbreak of diseases VHE

First Reports disease VHE under Article 5.

Second Ensuring the collection and transport of biological material of the patient and
contacts to verify the diagnosis of a competent laboratory.

Third Isolation of sick or suspect the disease in isolation wards
according to another law ^ 2).

Fourth For those who have been in contact with patients, implementing medical supervision
of 60 days from the last contact.

Fifth Receiving new people in communities preschool and school age
banned at the time of medical surveillance for occurrence of VHE
assessment by the locally competent public health protection authority.

6th Persons in contact with VHE performing activities epidemiologically serious
are excluded from these activities imposition of the increased medical surveillance
for a period of 60 days from the last contact with the patient.

7th For donors of blood and other biological material is governed by other laws
^ 5).

8th Cooperation with the authorities of the State Veterinary Administration.

1) § 15 of Act no. 258/2000 Coll., On protection of public health and amending
some related laws, as amended by Act no. 274/2003 Coll.

2) Decree no. 195/2005 Coll., Which regulates the conditions
prevent the emergence and spread of infectious diseases and hygiene requirements for the operation
medical facilities and social care institutions.

3) Annex 2 of Decree no. 143/2008 Coll., On
down detailed requirements for ensuring the quality and safety of human blood and its components
(Decree on human blood).

4) § 64 point. a) Act no. 258/2000 Coll., on public health protection and
amendment of related laws.

5) Act no. 296/2008 Coll., On ensuring quality and safety of human tissues and cells
intended for use in humans and changed
related laws (Act on human tissues and cells), as amended
regulations.

Act no. 285/2002 Coll., On donation, drafts and transplantation of tissues and organs
and amending certain acts (Transplantation Act), as amended
.

Decree no. 143/2008 Coll., On down detailed requirements for ensuring
quality and safety of human blood and its components (Decree on human blood
).

6) Directive of the Ministry of Health of the Czech Socialist Republic no. 30/1968
Bulletin MZ Czechoslovakia on measures against sexual diseases, as
Decree no. 225/1996 Coll. (Reg.čá. Directive 51/1968 Sb.)
.

7) Decree no. 386/2007 Coll., Laying down the disease, for which
provides follow-up care, time range dispensary examinations and marking
specialization dispenzarizujícího doctor.

8) Annex 5 of Decree no. 422/2008 Coll., On
down detailed requirements for ensuring the quality and safety of human tissues and cells intended for human application
.