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COMMUNICABLE DISEASE SURVEILLANCE IN CROATIA

n    Communicable disease case notification in AUGUST

T y p h u s   a b d o m i n a l i s. After one imported case in July, in August again  a zero incidence, as it was seen whole year. 

S a l m o n e l l o s i s. There were little less cases in August than in July (498:515), also less than in August last year (543). Small clusters are visible in Koprivnica (15), Osijek (23), Karlovac (34), Rijeka (17), Rovinj (22) and New Zagreb (25).

D y s e n t e r i a  b a c i l l a r i s. Low incidence pattern continues, with 4 reported cases in August.,

P a r o t i t i s    e p i d e m i c a (mumps) In August only 4 cases were reported, similarly to previous month (4) and to the last August (2), owing  systematic vaccination.

M e n i n g i t i s  v i r o s a. Incidence raised in August (40:26) which is also more than in August last year (25).

E n t e r o v i r o s i s. Like aseptic meningitis (etiology also mostly common) serous meningitis cases were more frequent in August than in July (49:35). This was also more than in last year August (24). Small cluster is seen in Zagreb Centar (10).

S y p h i l i s. There were 3 cases reported in August, which is slightly more than in July (0) and in  August last year (0). Since the beginning of this year the total of 18 cases were recorded which was also slightly more than in the same period last year (10).

M a l a r i a.  One imported  case (Tanzania) reported from Velika Gorica.

n     No cases reported in August from: Garešnica, Grubišno Polje, Vojnić, Novalja, Imotski, Kaštela, Solin, Lastovo, Metković and Jastrebarsko. Total: 10 out of 113 epidemiological districts.

n      Epidemic outbreaks

        Following outbreaks were reported in August:

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

Sisak - tuberculosis in a family with 3 diseased out of 4 family members  between August 2003 and June 2004. Source: probably a family member experiencing a disease relapse.

Sisak - hepatitis B in a family, with 1 diseased and 4 infected (without symptoms), out of 5 members on 12.6.2004. Source epidemiologically: probably a family member. Mode of spread: close contact within family

Novi Zagreb - salmonellosis (S. enteritidis) through cakes from a pastry shop on 26.6. 2004. There were 6 diseased. Salmonella found in cake samples. Source  not found.

Rovinj - salmonella food poisoning (S. enteritidis) in a hotel on 1.7.2004. There were 42 diseased (guests and staff) out of ca 900 exposed. Source and vehicle not found.

Labin - salmonella food poisoning (S. enteritidis) on  4.7. 2004, with 5 diseased out of 8 family members eating home made cakes with cream. Salmonella found in cake samples. Source not certain. As persons involved in cake preparation turned salmonella negative, eggs were suspected, but not examined.

Labin - acute gastroenteritis among guests and staff in a hotel complex, with 35 diseased out of ca 1100 exposed between 8.7. and 30.7. 2004. Causative agent: Norwalk (calici) virus, geno-group 1, detected in stool samples of diseased. Mode of spread most probably: contact, partly may be also via droplets. Common vehicle (food) not detected.

Poreč - salmonella food poisoning (S. enteritidis) in a hotel, starting on 12.7.2004. Total of 15 diseased (guests and staff). Vehicle not certain.

Labin - salmonella food poisoning (S. enteritidis) in a hotel with 16 diseased (guests and staff) out of 350 exposed, between 18.7. and 27.7. 2004. Vehicle epidemiologically: panned fish and fried turkey meat.

Zagreb Centar - salmonella food poisoning (S. enteritidis) on 22.7. 2004 in a group of persons eating their meal in a restaurant. Vehicle epidemiologically: fried chicken and cake with cream (not microbiologically examined).

Zadar - scabies in a family. On 22.7. 2004 there were 3 infested persons out of 5 exposed

Krk - salmonellosis (S. enteritidis) after a birthday party on 24.7. 2004. There were 16 diseased out of 20 exposed persons. Source unknown. Vehicle epidemiologically: home made cake.

Zagreb Centar - salmonella food poisoning (S. enteritidis) starting on 25.7. 2004 with 10 diseased (6 hospitalized). Vehicle epidemiologically: cakes from a pastry shop. Microbiological examinations in progress.

NEWS AND COMMENTS

n     Deceased from communicable diseases in Croatia in 2003

       In 2003 there were 67,207 cases of various communicable diseases (influenza excluded) registered in Croatia through the national case notifying system. Out of this huge number only a small proportion of cases had died. However, even such a small numbers deserve full attention and analysis in order to find ways to decrease them further, either by improving treatment effectiveness or by reducing total number of cases through appropriate preventive and control measures. The table below shows diseases causing death in 2003 in Croatia

      Tuberculosis is ranking first as in previous years. This reflects earlier situation with much higher incidence of cases, some of which had turned chronic and unfortunately  dying today in their old ages. Pneumonia affects also mainly elderly persons. There were 4 deaths caused by salmonellosis. This reminds us that all preventive and control measures are of great importance, and also points to the necessity of prompt reaction and proper treatment when such disease occurred. Each year some sporadic deaths from leptospirosis also occur, usually caused by Leptospira interrogans var. icterohaemorrhagiae as a consequence of exposure to rodent excreta in natural and rural environment.

      Out of the total of 87,954 influenza cases reported in 2003, no fatal cases i. e. direct letal outcomes recorded. However, a certain, not easily assessed proportion of deaths in persons with one or more chronic diseases can be partially attributed to influenza each year (a seasonal excess of deaths). But here an important medical intervention is systematically applied, i.e.  vaccination of elderly and chronically ill persons. During the 2002 campaign preceding 2003 influenza outbreak,  some 500,000 persons had been vaccinated.

n     Fox vaccination against rabies 

        In the number 2 issue of the Rabies Bulletin Europe journal (Apr-Jun 2004) an interesting article about vaccination of foxes can be found, titled The oral vaccination of foxes against rabies, taken from the Report of the Scientific committee on animal health and welfare. It can also be found on the Internet at:

www.who-rabies-bulletin.org/q2_2004/startq2_04.htm.l Here we are excerpting some details with few comments.

       Today, vaccination of foxes against rabies is performed using several types of live attenuated oral vaccines, incorporated in attractive baits. The majority of present vaccines contain attenuated rabies viruses, while one of them contains the vaccinia virus genetically altered with glicoproteine gene of the rabies virus. When live attenuated rabies virus vaccines are used, than a virological identification and differentiation between wild and vaccinal virus strains is necessary when dealing with isolates from animals. Bait  distribution can most easily be done by helicopters  sometime by airplanes (large areas etc.), or by hand in urban and suburban areas, with  a distance between lines of distribution from 300 to 500 m. The effect of vaccination can be expected if a terrain treated is not smaller than 5000 km² (roughly 70x70m ed. rem.). The actions are performed twice a year, in spring and autumn until the effects is achieved, and then for two years more. The overall success of fox vaccination programs is very good, and today a great number of European countries, especially western and northern countries, practically do not have silvatic rabies and, along with that, animal rabies at all.

n COMMUNICABLE DISEASES IN CROATIA    -    AUGUST  2004