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NEWS AND COMMENTS
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Decrease of pandemic flu incidence in the middle of winter
Flu pandemic in
Croatia shows an unexpected fall of incidence in the middle of winter i.e. at
usual time of onset of the influenza season. The Main wave lasted for 2 months
however, which is characteristic of influenza. The start was earlier than
usual, with low incidence since July (see ENEWS 11/20099) and with the onset of
the main wave at the beginning of November. The rise of incidence in November
was fast and steep, typically for influenza, however up to the end of December
the situation almost completely calmed down. Such surprising dynamics confirm
the experience that influenza still keeps many secrets and is very difficult to
be understood and predicted.
Graph 1
Pandemic flu main wave dynamics, Croatia 2009
Now, a question
arises what could happen in the following months of this winter in 2010.
It can be expected
that the usual seasonal influenza will arrive. For this season, as in previous
seasons, three virus strains are expected: seasonal A/H1N1/, also A/H3N2/ and B.
Respective composition of seasonal 2009/2010 vaccine was predicted and proposed
by the WHO: strains corresponding to A/H1N1/Brisbane, A/H3N2/Brisbane and
B/Brisbane.
Up to now only few
isolates of influenza virus, not being a pandemic H1N1pdm2009 were
registered in Europe (less than 1%), and no seasonal influenza activity.
What will be with
the pandemic flu H1N12009 in the future, is also difficult to assess. The clear
decrease of incidence registered, should imply that a substantial part of the
population became immune either through illness or through inapparent infection
but this is difficult to accept, knowing that this virus was new for almost the
entire population, except the oldests. An increase of the number of new,
susceptible persons is difficult to expect this season, as the acquired immunity
should not disappear in a few months, nor quick increase of proportion of new
nonimmune generations could occur. This suggests that no substantial increase of
incidence could be expected this winter, but rather a limited constant
circulation of the virus. However there is still a real possibility for another
significant wave next winter.
Thus the
vaccination against the pandemic H1N1/2009 flu is still relevant and justified,
and it can be done continuously without impatience or rush. This vaccination
combined with the seasonal vaccination can optimally complete a vaccinal
protection against flu taking into account that flu can be a severe disease for
anybody, especially for known high risk groups, like chronic patients, elderly
etc.
Current experience
with pandemic vaccination in the country is favorable regarding adverse side
effects, i.e. practically no side effects were recorded. However it is not
favorable regarding the interest for vaccination in the public, this being
substantially lower than for seasonal vaccination.
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Manual
for HIV counseling and testing
In December 2009 a
new improved edition (3rd in line) of the Manual for HIV counseling
and testing was issued, aimed to doctors and others working on counseling in
Centers for anonymous voluntary HIV counseling and testing all over the country
. This difficult and responsible work is done mainly by doctors specialists in
epidemiology supported somewhere by some other profiles, if not able to cover
entire amount of work. Besides detailed instructions about procedures and other
particularities of taking and labeling samples, processing samples and informing
about the test results, a great part of the book deals with topics of specific
interest for counselors, like communication skills in probably the most delicate
area of interhuman communication, then a review and comments on ethical and
moral aspects, as well as legal aspects of this work. The book contains also the
newest data about HIV/AIDS trends and epidemiological patterns in Croatia.
Several colored pictures document well the work of our ten Centers. The authors
of the book were mainly the epidemiologists of the Epidemiology service of the
Croatian national institute of public health, and also epidemiologists from
Public health institutes of Zagreb and Split, as well as other experts, from the
Infective disease teaching hospital Zagreb, Medical faculty of Zagreb (School of
public health), Neuropsychiatric hospital Popovaca and Faculty of law,
University of Zagreb.
Data about the
book.
Title: Prirucnik za HIV savjetovanje i testiranje (Manual for HIV counseling and
testing) language: Croatian. Format: 29 x 21 cm. 177 pages, 45 colored pictures.
Editors: Ministry of health and social welfare of Croatia and Croatian national
institute of public health, Zagreb, 2009.
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