COMMUNICABLE DISEASE SURVEILLANCE IN CROATIA

- Communicable disease case notification in January

S a l m o n e l l o s i s. Less cases reported in January than previous month (257:368), as usual for the season. The intensity is similar to January last year (252). Only cluster is seen in Rijeka (30).

D y s e n t e r i a   b a c i l l a r i s. No cases in January. A low intensity also in December (4) and last January (8).

T e t a n u s. One case reported from Osijek (elderly unvaccinated person).

P e r t u s s i s (whooping cough). Low incidence pattern, due to mass immunization, continues, with only 4 cases in January. Previous month and last January figures were a bit higher (9).

M o r b i l l i (measles). Cluster of 53 cases is recorded in January in contrast to the null incidence in previous month and January last year respectively. Cases are clustered on Zagreb area among unvaccinated persons (See: News and comments)

M e n i n g i t i s   e p i d e m i c a. The number of cases registered in January (10) is similar to previous month (8) and  to January last year (9).

T r i c h i n e l l o s i s.  The season started with 22 cases in January,  which is similar to January last year (20). Small clusters are registered in Osijek (12) and Vinkovci (8).   

L e g i o n e l l o s i s. There were 3 unconnected cases in January (Metković, Črnomerec, Krapina), 5 in previous month, nil in January last year.

I n f l u e n z a. Influenza wave arrived in last days of 2003. Up to the end of January 16 964 cases were registered.  Influenza virus A/H3N2/ detected.

- No reports in January from:  Glina, Cres-Lošinj, Delnice, Novalja, Gračac and Lastovo, total: 6 out of 113 epidemiological districts.

- Epidemic outbreaks

Following outbreaks were reported in January:

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

Opatija - salmonella food poisoning (S. java) among participants of a fishing competition on 10.11.2003.  There were 10 diseased out of 50 exposed. Vehicle epidemiologically: meals (particular meal not identified) prepared that day for participants in a restaurant. Subsequent  epidemiological investigation revealed two S. java carriers among restaurant staff.

Buzet - streptococcosis (sore throat and scarlatina) in a kindergarten. Between 17.11. and 29.12. 2003 there were 32 diseased out of 160 and 11 more  among house  contacts.

Varaždin - acute gastroenteritis in an elementary school. Between 24.11. and 5.12.2003 there were 23 cases out of 217 exposed persons. Causative agent not found, examinations on enteric bacteria, adenoviruses and enteroviruses were  negative. Mode of spread: probably by food (not identified) and partly by contact.

Osijek - trichinellosis in a family with 12 diseased between 15.12.2003 and 15.1.2004. Vehicle: home made half-dried pork meat sausages. Some of diseased tasted raw meat mixture while preparing sausages. Meat was previously examined and declared trichinella free, but by an unqualified and unlicensed person.

Sisak - influenza outbreak in a home for elderly persons. Between 5.1. and 13. 1. 2004 there were 33 diseased out of 120 exposed persons.

Osijek - family outbreak of trichinellosis on 12.1.2004 with 3 diseased. Vehicle: raw pork  meat  mixture for home made sausages. 

NEWS AND COMMENTS

• Influenza /2003/2004

Seasonal influenza epidemic started in last days of 2003, as expected. Weekly numbers of cases are rising  quickly typically for influenza. Up to the end of January a total 16964 cases were reported. The laboratory of the National influenza center of the Virology department of the Croatian national institute of public health identified influenza virus A/H3N2/ in all positive cases. At the moment, more cases are registered in northern parts of the country.

A comparison of weekly dynamics between the last year and current epidemic (graph), adjusted for onset (last year influenza came later, at the end of February), shows that the current outbreak is somewhat lower, but still in predicted range of medium size outbreaks.  

• Measles 2003/2004

At the end of December last year and in January this year a limited outbreak of measles occurred. Owing to the fact that measles are very rare nowadays (only 6 cases in 2002 and only 2 imported cases during 2003, as a consequence of mass immunization), the epidemiology service succeed to link all cases and to identify the source case too. This was a hospital patient (unvaccinated, exposed to measles abroad) who, while being in the prodromal, catharal stage and not yet diagnosed as measles, came in contact with few other patients (unvaccinated) in the same and some other hospitals, which caused further spread including an institution for mentally handicapped person. Total of 53 cases were recorded up to the end of January.  Among them 34 were unvaccinated, 14 without data (most probably also unvaccinated) and 5 vaccinated. The age of diseased is given in the table next page.

Several health workers (doctors and nurses) are among the diseased. As in all similar occasions, the epidemiology service promptly vaccinated all persons in the vicinity of diseased, if they were found unvaccinated or without documentation. Those with contraindications received gamaglobulin. The outbreak is under control,  few new cases still occur however.

Graph 1  Measles in Croatia 1988 - 2004

* 2004: preliminary data; reports in 1^st  month

It is worth mentioning that  the last  year of increased measles incidence in Croatia was the year 1998, with 648 registered cases (graph). That figure and even more the number of diseased in the current outbreak, are however far below the  prevaccinal level (vaccination introduced 1968/19969) when over 20 000 cases had been recorded per year.

This event reminds however that measles are highly contagious (in some of actual cases the contact was short and superficial), and a very high vaccination coverage over 95 % is essential for efficient control of the disease. It enhanced also the importance of good personal and vaccinators' documentation about previous vaccinations, in order to avoid unnecessary vaccinations and work.

COMMUNICABLE DISEASES IN CROATIA - JANUARY 2004