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COMMUNICABLE DISEASE SURVEILLANCE IN CROATIA

n    Communicable disease case notification in May

S a l m o n e l l o s i s. The number of diseased was higher in May than in April (330:171), but lower than in May last year (495). The only cluster is seen in Pozega (28).

H e p a t i t i s  A  (epidemic jaundice). A very low intensity continues (April: 2 May: 1).

P e r t u s s i s (whooping cough). There were slightly more cases in May (10:4) which is similar to May last year (13). Small clusters are visible in Krizevci (3) and Samobor (3).

Q   f e v e r. The incidence in May is lower than in April (11:23) and similar to May last year (  ). Small clusters are registered in Krk (3) and Drnis (3).

M a l a r i a. One imported (Kenya or Tanzania) case is reported from Petrinja.

L e g i o n e l l o s i s. One sporadic case is reported from Zagreb Trnje. The place of exposure not found.

n    No cases reported in May from: Kastela, Vis, Lastovo. Total: 3 out of 113 epidemiological districts.

n     Epidemic outbreaks

   Following outbreaks were reported in May:

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

Dugo Selo - acute gastroenterocolitis in an social institution starting on 9.3.2004. There were 160 diseased (3 deceased) out of 690 exposed. Causative agent not certain. All bacteriological and virological examinations turned negative. In four patients however a presence of verotoxin was demonstrated by PCR technique, suggesting possible E. coli O157: H7 etiology. But this agent was not detected microbiologically in any of patient samples neither in any other sample examined. Mode of spread probably by food. Vehicle epidemiologically: a meal of stewed pork liver, but not confirmed microbiologically.

Pula - acute gastroenteritis in a hospital. Between 16.3. and 19.4.2004 there were 126 diseased (patients and staff) out of 893 exposed persons. Mode of spread: most probably by contact. Causative agent: Norwalk virus of  genogroup 2, detected in 5 of 11 patient stools examined, with all other bacteriological and virological examinations negative. Owing to strict control measures, the outbreak was contained within few hospital wards and stopped.

Cakovec - head lice in a suburban settlement. On 4.3. 2004 there were 40 infested children found.

Zagreb, Peščenica - enterocolitis in a kindergarten group on 16.4.2004. with 7 diseased out of 18 exposed. Causative agent: rota virus. Mode of spread: contact

Pula - acute gastroenterocolitis in a kindergarten starting  on 14.4.2004. There were 12 diseased out of 25 exposed. Causative agent: rota virus. Mode of spread: contact.

Cakovec - outbreak of illness with respiratory symptoms and conjunctival injection in a group of workers repairing a fecal drainage installation in  underground space. Epidemiological investigation excluded infective etiology and revealed that exposition to drainage gasses in narrow, unventilated cellar was the cause. Outbreak vas assessed in cooperation with the Croatian institute of toxicology.

Sinj - salmonella food poisoning (S. enteritidis) after birthday celebration on 22.4.2004. All 10 participants tuned ill. Vehicle epidemiologically: home made cream cakes; no samples left for analyses.

Krapina - scarlatina in a kindergarten with 7 diseased out of 25 exposed between 29.4. and 7.5.2004.

Pozega - salmonella food poisoning (S. enteritidis) on a wedding banquet on 9.5.2004. There were 20 diseased out of cca 200 exposed persons. Vehicle not found among various dishes.

Zadar - food poisoning in a pastry shop on 21.5.2004. Vehicle epidemiologically: ice cream and pizza. Causative agent: Staphylococcus aureus found in ice cream and in few staff members.

NEWS AND COMMENTS

n      HIV infection in Croatia in 2003.

As usual, here we present the summary report of regular annual anonymous reports on HIV testing from all laboratories in the country. Those data, combined with individual AIDS and HIV notification data, can give better insight into actual epidemiological features of this infection in Croatia. The table below present the data, distributed by standard epidemiological categories.

Category	Tested	Positives	%
homo/bisex. persons	74	17	22.9
i.v. drug abusers	869	9	1.03
hemophiliacs	7	0	0
partner of HIV+ person	31	4	12.9
child of HIV+ mother	1	0	0
hospital patients*	4514	12	0.27
voluntary blood donors	1661124	4	0.002
heterosex. promiscuous p.	2395	13	0.54
other/unknown	20227	22	0.11
Total	194292	81	0.04

*AIDS cases included

The situation appears equal to the last year (see ENEW 7/2003) and can be again interpreted as rather favorable. This because of low overall prevalence of HIV positivity (0.04%), and even lower in voluntary blood donors with 0.002 % of positives or 4 out of 166124 tested. There were no positives among hemophiliacs. Category "other/unknown" in the table, deserves some attention, namely it became larger and larger through the years. For instance, it counted 2056 in 1991, but 20277 in 2003). This implies that additional effort to categorize persons from this group into some of relevant epidemiological groups, would be appreciated, in order to obtain more detailed epidemiological information.  

n      Human antirabic treatment in Croatia in 2003.

Basing on regular annual reports of all antirabic units in Croatia, here we are presenting  the overview of last year activities and situation. A total of 5685 person visited one of 26 antirabic stations in the country. After examination, in 1394 of them indication for postexposure treatment was established. All these person received the vaccine, while 76 (5.5%) received also the hiperimmune gamaglobuline (HRIG).  All treated had survived i.e. had not get rabies. There were no cases of autochtonous human rabies in Croatia since 1964. The next two tables are presenting standard data about exposed body parts in treated persons, as well as about animals being responsible for individual antirabic treatment.

Table 1 Treated persons by localization of their exposure

Exposed body part	No treated
arms	683
legs	539
head and neck	101
trunk	29
multiple localization	42
Total	1394

Table 2 Animals causing antirabic treatment in 2003.

Animal species	No treated	Animal species	No treated
dog	883	weasel	6
cat	232	bear	1
fox	88	hare	2
rat	81	dear	4
mouse	14	rabbit	4
rodent, unspec.	10	horse	9
cow	20	wolf	1
sheep	4	bat	2
swine	3	wild boar	2
badger	1	wild cat	2
martens	8	dormouse	6
poultry, unspec.	3	mole	1
squirrel	4	unspecified	3
skunk	1
		Total	1394

Table 3  Number of persons treated because of contact with dog

Year	1998	1999	2000	2001	2002	2003
No	824	940	809	836	748	883

Tables 2 and 3 show beside other also that number of persons treated because of contact with dogs, mainly dogs of unknown owners, raised again. This suggest that better care for dogs is needed.

COMMUNICABLE DISEASES IN CROATIA                        May  2004