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COMMUNICABLE DISEASE SURVEILLANCE IN CROATIA

n    Communicable disease case notification in OCTOBER

S a l m o n e l l o s i s. As expected for the season, the incidence decreased in October (714:929) but not as much as in October last year (635). Clusters are seen in Osijek (20), Rijeka (104), Dubrovnik (28), Zagreb Dubrava (25), Črnomerec (27), Novi Zagreb (37), Sesvete (21) Susedgrad (32) and Trešnjevka (46).

H e p a t i t i s A (epidemic jaundice). Incidence is low: 1 case in October, 1 in September, 3  in last October.

T e t a n u s. One case in Pakrac: old unvaccinated person

P e r t u s s i s (whooping cough). There were less cases in October than in September (34:40) but this was more than in October last year (9). Small clusters in Sisak (4) and Peščenica (5).

M o r b i l l i  (measles). No cases reported in October, neither in September and  October last year.

S y p h i l i s. Three cases reported, which is equally to previous month, all three from Zagreb area (Črnomerec, Dubrava, Trešnjevka).

H F R S  (hemorrhagic fever with renal syndrome). In October 1 case was reported from Zagreb Črnomerec, but acquired elsewhere.

L y m e   b o r r e l i o s i s. The number of cases decreased as expected (18:45) and is similar to October last year (20).

n      No reports in October from: Garešnica, Dvor, Glina, Kostajnica, Petrinja, Topusko, Kaštela, Makarska, Sinj, Vis and Lastovo. Total: 12 out of 113 epidemiological districts.

n     Epidemic outbreaks

        Following outbreaks were reported in October

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

Nova Gradiška - hepatitis B in a family, with 3 diseased between beginning of  February  and the end of July 2004 and 4 more symptomless virus carriers found, out of 11 exposed family members. Source of current outbreak: most probably a member (found chronically infected) who suffered an open injury at home at the end of 2003. This caused a contact exposure of another family member  (onset of illness: February) and consecutively two more contact cases.

Dubrovnik - salmonella food poisoning in a family (Salmonella spp.) after a family celebration on 25.7. 2004. There were 5 diseased out of 54 guests.  An infant child was also among diseased, it was hospitalized and then triggered control intervention. Vehicle epidemiologically: home made French salad and fruit cake. 

Donji Miholjac - family outbreak of salmonellosis (S. enteritidis) on 6.8. 2004. All  5 family members got ill. Vehicle: home made cream cakes in which salmonella was detected. Eggs were salmonella negative however.

Sisak - pertusssis among children in a suburban settlement with significant portion of immigrant population. Between 11.8. and 29.9. 2004. there were 7 diseased. Epidemiological inquiry revealed that 36 more children visited doctor because of cough during last month. The diseased were not vaccinated against pertussis. Epidemiology service stopped the outbreak applying chemoprophylaxis or vaccination as it was indicated.

Petrinja - cluster of enteropathogenic Ecsherichia coli carriership in a kindergarten staff discovered during their regular health check on 24.8. 2004. There were 3 cases among 60 exposed. Mode of spread not certain, possibly  by contact while nursing children.

Samobor - acute gastroenteritis 17.9.2004 in a group of workers eating their warm meal at work. There were 18 diseased out of 140 exposed. Vehicle: green pasta. Causative agent probably Bacillus cereus found in pasta samples in high density.

Novi Zagreb - acute gastroenteritis in a kindergarten between 23.9. and 25.9. 2004. There were 33 cases registered out of 233 exposed. Mode of spread most probably alimentary (short outbreak duration). Vehicle not found. Causative agent not found, all microbiological examinations negative.

Pula - acute gastroenteritis in a group of school children arriving from Zagreb on their seven-days excursion. The outbreak started on 28.9. 2004. soon after arrival to a hotel, so exposure during the trip was suspected, especially because only one of three busses (total of 108 children) turned affected with 33 diseased out of 48 passengers. Causative agent not clear, bacteriological examinations all negative, viral etiology possible. No common food detected. Exposure during the buss trip is suspected.

NEWS AND COMMENTS

n      Some preliminary results of investigation among influenza vaccinees

         At the start of actual  influenza vaccination campaign, it might be of interest to give here some preliminary results of an epidemiological inquiry conducted recently in Croatia. Two years ago the Epidemiology service of the Croatian national institute of public health initiated an operative research about certain characteristics of persons undergoing influenza vaccination, by using simple anonymous questionnaire for the vaccinees. A self made computer program application was created for that purpose named ANKETGRI.  All  individual answers were finally collected in electronic form in the Epidemiology unit of the Croatian national institute of public health. The project continues this season too.

      In the first research year the total of 2345 answers were collected from 10 Counties, which is, in spite of some obvious but unavoidable design shortcomings still a rather representative sample. Among vaccinees inquired persons of various ages were registered, ranging from 3 till over 90 years. More women than men tend to be vaccinated (1.4:1). The majority of vaccinees have some chronic disease, some of them are also in their old ages. This means that beside the age, chronic diseases are the main motive for vaccination. Among vaccinees hawing chronic diseases, cardiac diseases are on the first place (48%) followed by diabetes (16%) and respiratory diseases (14%) and then other various chronic diseases and conditions. The most important result of this investigation is a clear evidence in favor of  influenza vaccination benefits. In spite known fact that  influenza vaccination  provide limited protection, only 2.4 % of examinees (43 out of 1621) answered that they had influenza last winter, if they were regularly vaccinated each year, i.e. more than 97 % of persons vaccinated regularly, did not have influenza (by a personal opinion) in previous winter. Among persons vaccinated for the first time 37% (147 out of 395) answered that they were ill with influenza last season, this being obviously the main motive for their decision.

n    Questions and answers

      In everyday contacts with college doctors form all over the country, epidemiologists of the Epidemiology service - Referral center for epidemiology of the Croatian national institute of public health try to resolve together, many professional questions and doubts, in order to contribute to good quality level of national health service system. Some of questions and answers which might be interesting for others, we use to publish here under an occasional bullet "Questions and answers". This time two questions about immunization practice are presented.

Question: Can a person recently experiencing salmonella food poisoning be vaccinated with oral polio vaccine and when?

Answer: Oral polio vaccination should wait for approximately two weeks (convalescence). In this time salmonella carriership will most probably also stop. (stool check!). If salmonella carriership persists after this period but general health condition is good, such person can then be vaccinated.

Question: should a patient (school child) experiencing strong adverse reaction to previous BCG vaccination in its childhood, so called "bcg-itis", be vaccinated again  if this person  now turned negative on regular  tuberculin (ppd) testing.

Answer: vaccination should be avoided in such case              

n COMMUNICABLE DISEASES IN CROATIA    -    OCTOBER  2004