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COMMUNICABLE DISEASE SURVEILLANCE IN CROATIA

n    Communicable disease case notification in JUNE

S a l m o n e l l o s i s. Incidence raised in June (370:330), but this was less than in June last year (651). No clusters.

A n g i n a   s t r e p t o c o c c i c a (streptococcal sore throat).  Incidence raised, opposite to seasonal expectations (927:886). This was almost twice as much as in June last year (496). The highest numbers are seen in  Slavonski Brod (68), Čakovec (42), Varaždin (48), Velika Gorica (97), Zagreb Peščenica (58) and Novi Zagreb (97).

C r e u t z f e l d t  J a k o b  disease (CJD). One case reported in June. Investigation revealed that this was not a case of new variant of the disease (vCJD), associated to so called "mad cow disease".

Q   f e v e r. Number of cases is lower than in May (9:17), while 39 cases had been reported in June last year (39).

M a l a r i a. One imported (Sierra Leone) case is reported from Zagreb Susedgrad.

L e g i o n e l l o s i s. There were 2 cases registered in June, both from Zagreb Susedgrad, but not epidemiologically related.

T B E  (tick born meningoencephalitis). There were 3 cases reported, similarly to previous month (4).

P e r t u s s i s (whooping cough). A low incidence pattern without significant clusters continues, owing to systematic vaccination: June: 9, May: 10, June 2003: 7.

n      No cases reported from: Umag, Pag, Kaštela and Lastovo. Total: 4 out of 113 epidemiological districts.

n     Epidemic outbreaks

         Following outbreaks were reported in June:

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

Rijeka - salmonellosis in a family (S. enteritidis) on 27.3.2004 with all 4 members diseased. Vehicle not certain. Domestic eggs were suspected but were not examined.

Rijeka - salmonellosis in a family (S. enteritidis) on 28.4. 2004. Four members got ill. Vehicle not found.

Pula - food poisoning in a social institution on 4.5. 2004, with a total of 15 diseased out of 250 exposed. Causative agent: Clostridium perfringens. Vehicle epidemiologically: cauliflower with hard boiled eggs, not examined microbiologically.

Rijeka - salmonella food poisoning (S. enteritidis) in two connected families after a meal of scrambled eggs on 5.5. 2004. There were 4 diseased out of 9 exposed persons. Eggs  were not microbiologically examined.

Split - salmonella food poisoning (S. bovis morbificans) starting on 6.5. 2004 in  a group of  workers having  their lunch in a canteen. There were 35 diseased out of cca 120 exposed. Vehicle epidemiologically: backed pork meat. The same salmonella detected in patients, among  kitchen staff and in examined food samples (bacon, sausages) respectively. Source not found with certainty.

Vukovar - salmonella food poisoning (S. enteritidis) in persons eating home made cream cakes. Between 16.5. and 18.5. 2004 there were 10 diseased out of 31 exposed persons. Salmonella was found in cake samples. Source not found.

Pula - food poisoning in the same social institution (see above) on 18.5. 2004. There were 54 diseased registered out of 250 exposed. Causative agent (again): Clostridium perfringens. Vehicle epidemiologically: spinach, rice, panned turkey meat. But, food samples turned negative.

Rijeka - enterocolitis of unknown aetiology (microbiological examinations all negative) on 28.5. 2004 among workers building new highway. There were 7 cases reported out of 26 exposed. Vehicle epidemiologically: fried chicken and mash potato meal in a small local restaurant.

NEWS AND COMMENTS

n      Enteral bacteria in circulation, spring and early summer 2004

         The Laboratory for enteral bacteria of the Croatian national institute of public health is reporting on their positive findings in the April-June period. The table below is showing the structure and proportions.

It can be seen that intensity is rather low at the beginning of the summer.

n    Meeting of the Croatian epidemiological society of CMA

        The Croatian epidemiological society of the Croatian medical association, held its 56^th scientific symposium on 4^th and 5^th of June 2004 in the town of Vukovar. The meeting took place in the conference hall of the Pastoral center at the church of St. Bono, a town patron. More than 80 Society members, epidemiologists, from all over the country were present. Owing to hosts, esteemed colleagues epidemiologists of the Vukovarsko-srijemska county Institute of public health the meeting was organized superbly. Exceptionally touching was the atmosphere at the opening, when warm words of hospitality were sent from a parish priest of Vukovar, representatives of the County bureau of health and social care, Primary health care center, and of legendary Vukovar hospital.

During the sypmposium 25 lectures were presented, covering the wide range of epidemiology of infectious diseases and chronic mass diseases. Below, a list of  topics exposed and discussed is given.

·     Presentation of the Vukovarsko-srijemska County Institute of public health and its role

·     Some interesting experiences from the Antirabic station of the Institute of public health of the City of Zagreb

·     Work of antirabic stations of the Vukovarsko srijemska county Institute of public health 2000 - 2004.

·     Work of the Antirabic station Karlovac of the Karlovačka County Institute of public health 1994 - 2003.

·     Experiences of Slavonski Brod epidemiology service from the action of withdrawal and replacement of  withdrawn lot of rabies vaccine

·     Tuberculosis in a psychiatric ward

·     Sexual behavior and STD prevention

·     Epidemiology of viral hepatitis C

·     Drain pipe gases poisoning in Varaždin

·     Smoking in the automobile more dangerous than using mobile phones

·     Are females less affected with vascular diseases

·     Sudden cardiac death

·     Influence of industrial activities and predominant winds on the content of toxic metals and metalloids in fresh fruit and vegetable

·     Natural focus disease outbreak as a possible model of bio-terrorism

·     International health regulations (IHR) revisions in progress

·     Role of the HACCP system; experiences of the Primorsko-goranska county Institute of public health

·     Perinatal deaths in Šibensko-kninska county 1996-2003

·     Events and activities after arrival of two HIV positive children to the town of Kutina

·     Testing  i.v. addicts on hepatitis B, C and HIV markers in the Split area

·     Vaccination day, experiences in Splitsko-dalmatinska county

·     Results of  Program of mass vaccination in Croatia in 2003.

·     Whooping cough in persons regularly vaccinated against whooping cough.

·     Can vaccinal mumps be transmitted to non-immune persons

·     Measles outbreak in Zagreb

n        Composition of influenza vaccine for the 2004/2005 season

          In the WHO bulletin, the Weekly epidemiological record N^o 9, from 27^th of February 2004 proposed composition of vaccine for the forthcoming season on northern hemisphere is published. Like in previous years, the vaccine should have two different strains of influenza A viruses and influenza B virus strain. Those vaccinal strains should be like the following:

A/H1N1/ New Caledonia 99

A/H3N2/Fujian 2002

B/Shanghai 2002 

Regarding the Fujian strain it is noted that also appropriate are vaccinal strains A/H3N2/Wyoming 2002 and A/H3N2/Kuamamoto 2002,  while vaccinal strain B/Jilin 2003 applies for proposed strain B/Shanghai.

Having in mind that virus influenzae A/H3N2/ was dominant in the last season in Croatia, an outbreak of similar intensity, can be expected in the forthcoming season.

n COMMUNICABLE DISEASES IN CROATIA    -    JUNE  2004