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COMMUNICABLE DISEASE SURVEILLANCE IN CROATIA

n    Communicable disease case notification in April

S a l m o n e l l o s i s. Number of cases reported in April is slightly lower than in March (171:182), but in April last year the incidence was even lower (144). Small clusters are seen in Rijeka (12) and Rovinj (13).

E n t e r o c o l i t i s. Incidence raised in April compared to March (622:596), being also higher than in April last year (466). Cluster is observed in Dugo Selo (143) as a consequence of outbreak in a social institution.

D y s e n t e r i a    b a c i l l a r i s. Only 2 sporadic cases reported in April.

H e p a t i t i s   B. There were 19 cases in April which is slightly less than in March (23) and more than April last year  (9). All cases were unvaccinated, aged over 17.

P a r o t i t i s  e p i d e m i c a.  Only 3 sporadic cases in April (Virovitica, Vinkovci, Metkovic), owing to systematic vaccination.

S y p h i l i s. There were 3 unlinked cases in April (Pozega, Donji Miholjac, Split).

Q  f e v e r. Number of cases registered in April is higher than in March (23:4) but it was not as high as in April last year (31). Small clusters are visible in Zadar (9; see Epidemic outbreaks) and Drnis (8).

I n f l u e n z a. Actual outbreak practically finished in April, with 571 more cases (9400 in March).    

n   No reports in April from: Cres-Losinj, Gracac, Vrgorac. Total: 3 out of 113 epidemiological districts.

n   Epidemic outbreaks

   Following outbreaks were reported in April:

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

Dubrovnik - head lice in an elementary school. On 4.2. 2004. there were 19 infested in a group of 131 pupils.

Brac - scarlatina in a kindergarten. Between 5.2. and 9.3.2004. there were 13 diseased out of 56 exposed children

Sinj - salmonella food poisoning (S. enteritidis) on 12.2.2004 among participants of a wedding banquet, with a total of 11 cases registered among 19 exposed. Vehicle epidemiologically: birthday cake, no samples left for analyses.

Zupanja - trichinellosis in a family with 5 diseased out of 13 members between 24.2. and 10.3. 2004, all eating own home made dried pork meat products. Trichinella was found in meat product samples but preliminary testing of fresh meat has been negative.

Zadar - Q fever  with 13 diseased between 3.3. and 12. 3. 2004. The diseased are all employed in a small factory and working in a part of building bordering a meadow where sheep were grazing.

Sisak - streptococcal sore throat in a kindergarten. There were 10 diseased out of 74 exposed between 8.3. and 1.4. 2004.

Sinj - enterocolitis in an institution for medical rehabilitation, with 48 cases registered among 178 exposed persons between 10.3. and 25.3. 2004. Causative agent not found, all bacteriological examinations, as well as examinations on rota  and adeno viruses turned negative. Mode of spread: contact

Rovinj - salmonella food poisoning (S. enteritidis) in a kindergarten on 11.3. 2004. Total of 24 cases were registered out of 70 exposed children. Source and mode of spread not found, in spite thorough investigation.

Ivanic Grad - streptococal sore throat in an elementary school. Between 12.3. and 22.3.2004 there were 27 diseased out of 97.

Pula - hospital outbreak of acute gastroenteritis in neonatology and pediatric ward  with 10 cases between 19.3. and 28.3. 2004. Causative agent: rota virus, detected in 10 out of 15 stool samples examined. Mode of spread: contact. Applied control measures successfully stopped the outbreak. 

Split - acute enterocolitis in a restaurant on 30.2. 2004. with 11 diseased. Causative agent not found, microbiological examinations negative. Vehicle epidemiologically: ground meat. 

NEWS AND COMMENTS

n      Realization of Program of mass immunizations in Croatia in 2003.

As usual, here we are presenting the data about results of annual Program of mass immunization in Croatia for previous year 2003, basing on regular  reports of all vaccinators all over the country. The table below is giving the newest data compared with few pervious years.

Coverage rates for primary vaccination in Croatia

Vaccination	2003.	2002.	2001.	2000.	1999.
DTP	94.4%	94.7%	94.4 %	93.3 %	92.9 %
Polio	94.7%	94.8%	94.2 %	93.5 %	93.3 %
MMR	94.5%	94.7%	93.6 %	93.2 %	92.4 %
hepatitis B	97.9%	97.1%	97.9 %	97.7 %
BCG	98.1%	98.9%	95.2 %	95.0 %	93.6 %
Te	68.2%	65.1%
Hib	94.5%	78.9%

It can be seen that coverage rates are generally similar to those of previous year.  This means that they can again be described as  favorable and  satisfactory, achieving over 90% for: diphtheria, tetanus, pertussis, tuberculosis, poliomyelitis, rubella and parotitis epidemica and first time this year also for vaccination against Haemophilus influenzae type b. Immunization of 60 years old persons against tetanus which was introduced last year has been performed better than last year (68.2% : 65.1%) as predicted, but still not satisfactory i.e. under 90%. The vaccination coverage rate for measles which should be very high (95%) was not reached, though only for very little portion (94.5%). The recent small  measles outbreak occurring this winter (see ENEW 1/2004) with predominantly unvaccinated persons involved,  showed us how important the high coverage is in achieving and maintaining  stabile measles elimination stage.

n      Hepatitis A outbreaks in Croatia 1999 - 2003.

Hepatitis A shows a dramatic retreat in last years in Croatia, however with  preserved natural cyclic oscillations and occasional so called epidemic years but  at lower and lower level (Table)

In the frames of such low incidence situation still some outbreaks are occurring. Their analysis can give us valuable information about current modes and circumstances of hepatitis A spread and thus better possibilities for further control and prevention. The next table is giving data about hepatitis A outbreaks registered in last 5 years.

Place /group	No outbreaks	Mode of spread	Vehicle
family	4	contact
elementary school	1	contact
children home	1	contact
junior judo club	1	contact
village	2	contact
suburban settlement*	8	contact
small town	1	hydric**
tourists traveling  abroad	2	alimentary	green vegetable
wedding party	1	alimentary	not identified
urban population	1	alimentary	mussels (unconfirmed virologically)

* suburban settlements with pore sanitation
** contributing factors: repeatedly lack of water in the system, no chlorination

n      Hepatitis B in Croatia

In 2003 there were 180 registered cases of hepatitis B in Croatia. This was less than in few previous years (see Graph) but still within already observed limits of stationary pattern of this diseases.

Hepatitis B in Croatia  1984 - 2003

As in Croatia rather good coverage of risk groups is maintained since 1989 (health workers, dialyzed patients etc.) combined with vaccination of all newborns of HBsAg positive mothers (based on systematic testing of all pregnant women since 1999) and finally with systematic vaccination of 12 years old children cohorts (6th class) since 2000 (4 generations up to now) it would be interesting to analyze the structure of diseased regarding their vaccinal status. So, in 2003 all diseased except one (a 45 years old female) were unvaccinated. The age analysis shows that among 180 diseased there were no cases aged 12 - 15, i.e. from cohorts covered by the Program.

COMMUNICABLE DISEASES IN CROATIA                                        April  2004