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COMMUNICABLE DISEASE SURVEILLANCE IN CROATIA

n    Communicable disease case notification in December

S a l m o n e l l o s i s. Incidence decreased (302:517) as expected for the season, being similar to December last year (368). No significant clusters.

H e p a t i t i s A (epidemic jaundice). Low incidence pattern continues: Nov.: 9, Dec.: 6, Dec. 2003 :1.

P e r t u s s i s (whooping cough). Number of cases is higher than previous month (21:18) and also higher than in December last year (9). Small clusters in Petrinja (4) and Klanjec (4).

V a r i c e l l a (chicken pox). Steep seasonal increase is observed (2016:1260). Last year situation was similar (2126).

S y p h i l i s. There were 15 cases reported in December, which is more than in November (5) and also more than in December last year (7). Cases cluster in Zagreb and surrounding and are epidemiologically linked.

P n e u m o n i a. Incidence raised further in December (1305:619) being significantly higher than in December last year (266). Highest numbers are seen in Slavonski Brod (62), Vinkovci (32), Vukovar (54), Kutina (59), Novska (57), Crikvenica (32), Labin (50), Varaždin (39), Samobor (46), Velika Gorica (33) and Zagreb City area (412). As reported in last number of ENEWS, Mycoplasma pneumoniae seems to be dominant etiological agent.

n      No reports in December from: Pakrac, Cres-Lošinj, Rovinj, Pag and Lastovo. Total: 5 out of 113.

n      Epidemic outbreaks

Following outbreaks were reported in December

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

Crikvenica - Q fever in a small town and its surrounding. Between 2.2. and 1.8. 2004 total of 24 cases were registered. Source: sheep, grazing in the town vicinity, proven to be infected by the veterinary investigation.

Županja - erithema infectiosum ("fifth disease") in a kindergarten. There were 21 diseased out of 214 exposed between 13.9. and 12.11. 2004. Causative agent: parvovirus B19. Mode of spread: via droplets.

       Ed. rem.: this disease is not on the list for individual notification, but an outbreak, as well as any other outbreak, is to be noticed and reported. So, this was an example of correct epidemiological and etiological investigation and reporting.

Rijeka - salmonella food poisoning (S. enteritidis) in few elementary schools getting their meals from the same central kitchen. Vehicle epidemiologically: meatloaf. Source not certain. Eggs were suspected but not examined. Between 14.9. and 18.9. 2004 there were 97 diseased out of 660 exposed children.

Rijeka - salmonella food poisoning (S. enteritidis)  in a restaurant on 21.9. 2004. There were 6 cases out of 17 exposed persons. Vehicle epidemiologically: cakes with cream. Epidemiological investigation revealed salmonella carriership among kitchen staff.

Rijeka - acute gastroenteritis among school children returning from their one-day excursion. Total of 32 diseased out of 42 exposed were registered. No common food or drink found. Epidemiological investigation suggests a combined aerogenic and contact spreading mode in the buss during travel. Bacteriological examinations all negative; viral etiology possible. 

Rijeka - enterocolitis among restaurant guests on 30.9.2004. There were 2 diseased out of 4 exposed. Vehicle epidemiologically: stuffed calamares.

Split - hydric outbreak of enterocolitis in an village starting on 1.10. 2004 through   a local, technically damaged water supply system lacking chlorination. Causative agent: Aeromonas hydrophila, found in diseased as well as  (beside other increased coliforme bacteria) in  water samples.

Petrinja - streptococcal sore throat in a  public institution. Between 21.10. and 15. 11. 2004 there were 7 diseased out of 22 exposed.

Šibenik - scabies in a social institution starting at the end of October. On November the 20^th 2004 total of 100 infested  have been detected.

Pula - trichinellosis among consumers of dried pork sausages purchased on two locations in the town. Epidemiological investigation pointed to the products originating from another County where cases also occurred after consumming the same product. Trichinella was found in sausage samples. Between 1.11. and 10. 12. 2004 there were 36 diseased.

Zagreb Črnomerec - acute enterocolitis in a home for elderly persons on 7.11. 2004.  Total of 102 cases out of 120 exposed were recorded. Causative agent not found, possibly  a virus; bacteriological examinations all negative. Mode of spread not certain, probably aerogenic.

Knin - scabies in a home for elderly people with 25 infested on 10.11. 2004.

Knin - gastroenteritis in a school. Between 11.11. and 25. 11. 2004 there were 25 diseased out of 59 exposed. Mode of spread not certain. Causative agent not found, possibly a virus; bacteriological examinations negative. Hydric spread is suspected, as the school water supply had been found microbiologically contaminated.

Zagreb Peščenica - food poisoning in a home for elderly people starting 24.11. 2004. There were 36 diseased out of 182 exposed. Vehicle not found.

Kutina - acute gastroenteritis in a psychiatric hospital. Between 30.11. and 9. 12. 2004 the total of 24 cases was registered out of 300 exposed persons. Causative agent: Norwalk virus genogroup 2, found in two of four patients examined while all other bacteriological and virological examinations turned negative. Mode of spread most probably combined: alimentary and by contact.  

Rijeka - acute gastroenteritis in a home for elderly persons. Between 15.12. and 19.12. 2004 there were 15 diseased out of 240 exposed. No common food detected. Causative agent not found, possibly a virus, bacteriological examinations all negative. Mode of spread: contact.

NEWS AND COMMENTS

n      Respiratory viruses in circulation, at the onset of winter

       According to reports from the Laboratory for respiratory viruses and National influenza center of the Croatian national institute of public health, the late autumn and beginning of winter 2004/2005 are characterized by a typical respiratory virus spectrum i.e.: adenoviruses, parainfluenza v. and RS viruses, but RS viruses being significantly more frequent than in previous years. At the moment of writing this article (first week of January 2005), influenza is not arrived yet. One solitary case reported in December was not virologically confirmed.

n      Meeting of the Croatian epidemiological society of CMA

       On December the 3^rd 2004  the Croatian epidemiological society of the Croatian medical association held its 57^th winter scientific meeting in Zagreb. The meting took place in newly adapted conference hall of the Institute of public health of the City of Zagreb, with more than 100 attendants, epidemiologist from all over the country.  Beside the usual program of scientific and professional topics, this meeting started with a small celebration, i.e., promotion of new textbook, the General epidemiology,  written by the two prominent epidemiologists Prof. dr. Dinko Puntarić and Prof. dr. Darko Ropac. Before actual start, the "minute of silence" was dedicated to recently deceased bard of Croatian epidemiology, former president of the Croatian epidemiological society Prof. dr. Berislav Borčić. Within the working part of the meeting 18 original papers and lectures were presented and discussed. Beside communicable disease epidemiology topics, strong block of non-communicable disease titles was noticed, reflecting modern trends and progress of Croatian epidemiological profession. Below, titles presented during the meeting are listed.

- Communication of a report about possible (first) successful treatment of human rabies case in USA

- Trichinellosis prevention

- Epidemiology of AIDS in Croatia

- Report about work of  AIDS/HIV counseling center in Split

- Outbreak of parvoviral infectious erythema in a kindergarten in Županja

- Isolation of Vibrio cholerae NAG, in a person returning from abroad

- Report on recent status of realization of the future University hospital in Zagreb

- Hearth failure, epidemiological aspects

- Epidemiology of injuries of high mortality

- Epidemiology of breast cancer

- Bone mass in children and adolescents related to diet and physical activity

- Significance of the vitamin C intake through commercial fruit juices

- Presentation of new guide book: Health self-care; diabetes and me

- Effect of ambulant rehabilitation in patients with, or without percutaneous coronary intervention in acute myocardial infarction

- Pertussis, epidemic or endemic

- Epidemiology of HCV infection among i.v. drug abusers in Zadarska county

- Twenty years follow up of chronic HBV carriers and their family members in Slavonski Brod area

- Geographic distribution of tick born encephalitis cases in Croatia  1999 - 2004.

n      AIDS in Croatia 2003

         In the Epidemiological news N^o 5 some data on HIV infection distribution and trends in Croatia were published. Here we are adding information about AIDS cases. There were 10 new cases registered in Croatia in 2003. This was similar to previous years.

These cases, like the majority of all previous cases, belong to some of known high risk groups. A cumulative total of cases since 1986 when first 2 were registered in Croatia, currently yields 210, or 46 per 1 million inhabitants. This puts Croatia among European countries with low incidence. Males are more affected than females (179:31 or 85:15%). The structure of diseased is given in  table below.

Table 1   AIDS cases in Croatia, 1986 - 2003 cumulative

* the majority of this group had acquired the disease abroad

Out of the above cumulative total figure, 114 patients (54%) had died.

COMMUNICABLE DISEASES IN CROATIA                                 December 2004

CONTENTS OF THE  EPIDEMIOLOGICAL NEWS

IN 2004

Epidemiological comments                                                                   N^o ENEWS
 

Work and problems of epidemiology  services

Graphs and pictures

Permanent titles

Individual case notification dynamics in Croatia (commentary)

Epidemiological districts without notifications

Epidemic outbreaks reported  in current month

Communicable diseases notified in current month (numeric table)