ENGLISH LANGUAGE ISSUE

COMMUNICABLE DISEASE SURVEILLANCE IN CROATIA

• Communicable disease case notification in November

S a l m o n e l l o s i s. After last month rise, the incidence is again lower in November (418:635) being also lower than in November last year (559). Clusters are seen in Rijeka (29), Zagreb Peščenica (20), Trešnjevka (21) and Novi Zagreb (26).

A n g i n a s t r e p t o c o c c i c a (streptococcal sore throat). Significant increase of incidence is observed in November (1177:708). This was more than in November last year (673). The highest numbers registered in Sisak (71), Čakovec (75), Varaždin (44), Samobor (45), Velika Gorica (66), Zagreb Črnomerec (44) and Novi Zagreb (69).

V a r i c e l l a (chickenpox). Usual seasonal increase is in progress (1111:401), but intensity is lower than a year ago (1459). 

A I D S. 3 cases reported in November (Osijek, Hvar, Zagreb Trešnjevka) had occurred during last five months.

M a l a r i a. There were 3 reports in November (Cres-Lošinj, Rijeka, Ivanić Grad) all imported (Africa, Asia).

K a l a a z a r. One case is registered in November in Osijek but actually acquired in Adriatic coastal region.
 

• No reports in November from: Rab, Labin, Pag, Brač, Imotski, Vis, Lastovo. Total: 7 out of 113.
  
  
  

• Epidemic outbreaks

Following outbreaks were reported in November:
Note: in all outbreaks mentioned here, epidemiological investigation and all necessary measures were undertaken, preventing thus other potential cases.

Vinkovci - salmonella food poisoning (S. typhimuirum) on a wedding party on 17.8.2003. There were 22 diseased out of cca 200 exposed. Source and vehicle not discovered among various meals served.

Umag - salmonella food poisoning (S. enteritidis) after a birthday party on 5.9. 2003. There were 12 cases out of 18 exposed persons. Vehicle epidemiologically: chocolate cake, obtained form a pastry shop. Source: probably some of the pastry shop staff, subsequently found carrying S. enteritidis.

Karlovac - salmonella food poisoning (S. typhimurium) on 14.9.2003. among participants of a wedding banquet held in a restaurant. There were 23 diseases out of cca 200 exposed persons. Epidemiological and microbiological investigation in the restaurant (facilities, staff, food) did not reveal any salmonella

Dubrovnik - acute gastroenteritis in group of guests just arriving to a hotel. Few cases were registered already during the trip. Altogether 26 diseased out of 73 exposed were registered between 23.9. and 22.10 2003. Causative agent not found, all microbiological examinations in patients were negative.

Dubrovnik - small cluster of salmonellosis (Salmonella of B group) discovered retrospectively after one of hotel staff underwent his regular health check and had been found a salmonella carrier. Two more symptomless carriers were found through subsequent preventive microbiological screening of all hotel staff. Source and vehicle unknown. There were no diseased among hotel guests.

Zabok - scarlatina in an elementary school with 4 diseased out of 21 members of same class between 6.10. and 31.10. 2003.

Zabok - scarlatina in another elementary school with 4 diseased out of 25 members of same class between 23.10. and 23. 10. 2003.

Sisak - streptococcosis (sore throat and scarlet fever) in a kindergarten. Between 20.10. and 10.11.2003 there were 7 cases out of 148 children present.

Ivanić Grad - acute gastroenterocolitis in a kindergarten with 12 diseased out of 65 exposed between 27.10. and 5.11. 2003. Causative agent: most probably rotavirus, found in few patients, with bacteriological examinations all negative. Mode of spread as well as possible common food exposure not found.




NEWS AND COMMENTS

• The 110^th anniversary of the Croatian national institute of public health

On November 27^th 2003 a celebration of 110 years of existence and work of public health institutions on national level in Croatia, aimed specifically for health protection and prevention of diseases of entire population - today's Croatian national institute of public health being a direct continuation - took place in the Opera hotel in Zagreb. Representatives of other public health institutes, related professions, veterinarians, pharmacists etc, representatives of the Ministry of health, as well as present and former employees of the Institute were present. As the starting point for this anniversary the year 1893 was chosen, when the Royal national institute for the production of animal vaccine against smallpox had been founded in Zagreb in Gundulićeva street.

For the celebration a representative monograph book about the Institute was published, written by a group of Institute members. On its 125 pages, richly illustrated with interesting old and new photographs, the book is telling the story about the roots, the centennial develop and the present state of the Institute and its parts: epidemiology, microbiology, ecology, social medicine, logistic services, directorate etc. On the 28^th page of the book the genealogy of the institute was given: 

1893. Royal national institute for animal vaccine against smallpox production 
1907. Royal national bacteriological hygienic institute 
1912. Royal national bacteriological institute
1923. Epidemiological institute
1926. Hygienic institute (Institute for hygiene)
1926. Hygienic Institute with School of public health
1930. Hygienic institute in Zagreb
1939. Division for hygienic services
1942. Health institute
1946. Hygienic Institute
1951. Central hygienic institute
1961. Republic Institute for health protection (for public health)
1970. Institute for public heath of the SR Croatia
1990. Institute of public health of the Republic of Croatia
1994. Croatian national institute of public health

Here we also excerpt the information that the Epidemiology service became a distinct operative part of the Institute in 1930 (over 70 years now) when the first Epidemiological division had been founded within the Bacteriological-epidemiological department of that time Hygienic Institute in Zagreb. It should also be noticed that in certain period of its history the entire Institute had the name the Epidemiological institute (1923 -1926).

Beside the book, a documentary film about present Croatian national institute of public heath was also created and presented on the celebration.

First edition of the book is almost entirely expired due to great interest, but a number of copies of CD version of the book are still available at the editor the Croatian national institute of public health, 10000 Zagreb, Rockefellerova 7. 

• Q fever in Croatia 2003.

During this winter and spring a rather high activity of Q fever was recorded in Croatia, highest in last 12 years, with the total of 204 reported cases up to November. The most affected were the Splitsko-dalmatinska, Šibensko-kninska and Zadarska Counties. Distribution of diseased by month of onset (Graph 1) looks typical, reflecting main lambing season, as sheep were the main source of infection for the diseased persons, as usual (see Epidemic outbreaks in ENEWS 2/2003 and 6/2003.) 

Graph 1. Occurrence of Q fever cases by months of 2003 in Croatia



There were significantly more males than females (154:50) among diseased. Age distribution (Graph 2) corresponds to predominant age of persons caring after animals or being exposed to those animals in other way due to their profession.

Graph 2. Age structure of Q fever cases 2003.




COMMUNICABLE DISEASES IN CROATIA, November 2003

Typhus abdominalis (typhoid fever)	0
Salmonellosis	418
Food poisoning	366
Enterocolitis	679
Dysenteria bacillaris	1
Hepatitis A	6
Hepatitis B	18
Hepatitis C	20
Hepatitis vir. unidentified	1
Angina streptococcica	1177
Scarlatina	308
Pertussis	4
Varicella	1111
Parotitis epidemica	3
Meningitis epidemica	4
Meningitis virosa	23
Encephalitis	5
Leptospirosis	2
Mononucleosis infectiosa	176
Erysipelas	127
Tuberculosis	109
Gonorrhoea	2
AIDS	3
Q fever	3
Tularemia	1
Echonococcosis	2
Malaria	3
Scabies	50
Toxoplasmosis	6
Kala azar	1
Meningitis bacterial	2
Legionellosis	1
Enterovirosis	21
Pediculosis	32
Taeniasis	1
Pneumonia	259
Herpes zoster	261
Lyme borreliosis	20
Fievre boutoneuse	1
Chlamidiasis	83
Helminthiasis	48